title: Development and Validation of Consensus Contouring Guidelines for Adjuvant Radiation Therapy for Bladder Cancer After Radical Cystectomy.
abstract: To develop multi-institutional consensus clinical target volumes (CTVs) and organs at risk (OARs) for male and female bladder cancer patients undergoing adjuvant radiation therapy (RT) in clinical trials.
  
  
  
  We convened a multidisciplinary group of bladder cancer specialists from 15 centers and 5 countries. Six radiation oncologists and 7 urologists participated in the development of the initial contours. The group proposed initial language for the CTVs and OARs, and each radiation oncologist contoured them on computed tomography scans of a male and female cystectomy patient with input from ≥1 urologist. On the basis of the initial contouring, the group updated its CTV and OAR descriptions. The cystectomy bed, the area of greatest controversy, was contoured by another 6 radiation oncologists, and the cystectomy bed contouring language was again updated. To determine whether the revised language produced consistent contours, CTVs and OARs were redrawn by 6 additional radiation oncologists. We evaluated their contours for level of agreement using the Landis-Koch interpretation of the κ statistic.
  
  
  
  The group proposed that patients at elevated risk for local-regional failure with negative margins should be treated to the pelvic nodes alone (internal/external iliac, distal common iliac, obturator, and presacral), whereas patients with positive margins should be treated to the pelvic nodes and cystectomy bed. Proposed OARs included the rectum, bowel space, bone marrow, and urinary diversion. Consensus language describing the CTVs and OARs was developed and externally validated. The revised instructions were found to produce consistent contours.
  
  
  
  Consensus descriptions of CTVs and OARs were successfully developed and can be used in clinical trials of adjuvant radiation therapy for bladder cancer.
authors: Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Brian C
authors: BC
authors: Baumann
authors: Washington University in St. Louis, St. Louis, Missouri.
authors: Walter R
authors: WR
authors: Bosch
authors: University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
authors: Amit
authors: A
authors: Bahl
authors: Royal Preston Hospital, Preston, United Kingdom.
authors: Alison J
authors: AJ
authors: Birtle
authors: University of Ottawa, Ottawa, Ontario, Canada.
authors: Rodney H
authors: RH
authors: Breau
authors: University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
authors: Amarnath
authors: A
authors: Challapalli
authors: University of California San Francisco, San Francisco, California.
authors: Albert J
authors: AJ
authors: Chang
authors: Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The University of Manchester, Manchester Academic Heath Science Centre, Manchester, United Kingdom.
authors: Ananya
authors: A
authors: Choudhury
authors: University of Southern California, Los Angeles, California.
authors: Sia
authors: S
authors: Daneshmand
authors: Saskatoon Cancer Centre, Saskatoon, Canada.
authors: Ali
authors: A
authors: El-Gayed
authors: Massachusetts General Hospital, Boston, Massachusetts.
authors: Adam
authors: A
authors: Feldman
authors: Cancer Treatment Centers of America, Tulsa, Oklahoma.
authors: Steven E
authors: SE
authors: Finkelstein
authors: Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Thomas J
authors: TJ
authors: Guzzo
authors: University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
authors: Serena
authors: S
authors: Hilman
authors: Emory University, Atlanta, Georgia.
authors: Ashesh
authors: A
authors: Jani
authors: Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors: S Bruce
authors: SB
authors: Malkowicz
authors: 21(st) Century Oncology, Scottsdale, Arizona; 21st Century Oncology, Fort Myers, Florida.
authors: Constantine A
authors: CA
authors: Mantz
authors: Emory University, Atlanta, Georgia.
authors: Viraj
authors: V
authors: Master
authors: University College London Hospital, London, United Kingdom.
authors: Anita V
authors: AV
authors: Mitra
authors: Tata Memorial Center, Mumbai, India.
authors: Vedang
authors: V
authors: Murthy
authors: University of California San Francisco, San Francisco, California.
authors: Sima P
authors: SP
authors: Porten
authors: Institut Bergonié, Bordeaux, France.
authors: Pierre M
authors: PM
authors: Richaud
authors: Institut Bergonié, Bordeaux, France.
authors: Paul
authors: P
authors: Sargos
authors: Massachusetts General Hospital, Boston, Massachusetts.
authors: Jason A
authors: JA
authors: Efstathiou
authors: University of Ottawa, Ottawa, Ontario, Canada.
authors: Libni J
authors: LJ
authors: Eapen
authors: Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: christojo@uphs.upenn.edu.
authors: John P
authors: JP
authors: Christodouleas
mesh_terms: D003131:Combined Modality Therapy / Q000592:standards; D015653:Cystectomy / Q000592:standards*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D000072662:Margins of Excision; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D018787:Radiation Oncology / Q000592:standards; D018714:Radiotherapy, Adjuvant / Q000592:standards*; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000628:therapy*; D014572:Urology / Q000592:standards