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Abstract

INTRODUCTION:

The delineation of Clinical Target Volume (CTV) is a critical step in radiotherapy. Several guidelines suggest different subvolumes and anatomical boundaries in rectal cancer (RC), potentially leading to a misunderstanding in the CTV definition. International consensus guidelines (CG) are needed to improve uniformity in RC CTV delineation.

MATERIAL AND METHODS:

The 7 radiation oncologist experts defined a roadmap to produce RC CG. Step 1: revision of the published guidelines. Step 2: selection of RC cases with different clinical stages. Step 3: delineation of cases using Falcon following previously published guidelines. Step 4: meeting in person to discuss the initial delineation outcome, followed by a CTV proposal based on revised and if needed, adapted anatomical boundaries. Step 5: peer review of the agreed consensus. Step 6: peer review meeting to validate the final outcome. Step 7: completion of RC delineation atlases.

RESULTS:

A new ontology of structure sets was defined and the related table of anatomical boundaries was generated. The major modifications were about the lateral lymph nodes and the ischio-rectal fossa delineation. Seven RC cases were made available online as consultation atlases.

CONCLUSION:

The definition of international CG for RC delineation endorsed by international experts might support a future homogeneous comparison between clinical trial outcomes. 

Author information

Valentini V1, Gambacorta MA2, Barbaro B3, Chiloiro G4, Coco C5, Das P6, Fanfani F7, Joye I8, Kachnic L9, Maingon P10, Marijnen C11, Ngan S12, Haustermans K13.

1Università Cattolica del Sacro Cuore, Radiation Oncology Department, Rome, Italy. Electronic address: vincenzo.valentini@unicatt.it.

2Università Cattolica del Sacro Cuore, Radiation Oncology Department, Rome, Italy. Electronic address: magambacorta@rm.unicatt.it.

3Università Cattolica del Sacro Cuore, Department of Radiological Sciences, Rome, Italy. Electronic address: bbarbaro@rm.unicatt.it.

4Università Cattolica del Sacro Cuore, Radiation Oncology Department, Rome, Italy. Electronic address: vchiloiro@gmail.com.

5Università Cattolica del Sacro Cuore, Department of Surgical Science, Rome, Italy. Electronic address: coco_claudio@rm.unicatt.it.

6University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, USA. Electronic address: PrajDas@mdanderson.org.

7University G. D'Annunzio, Gynecologic Oncology Department of Medicine and Aging Sciences, Chieti, Italy. Electronic address: francesco.fanfani@unich.it.

8KU Leuven - University of Leuven, Department of Oncology and University Hospitals Leuven, Radiation Oncology, Belgium. Electronic address: ines.joye@uzleuven.be.

9Boston Medical Center, Department of Radiation Oncology, USA. Electronic address: lisa.kachnic@bmc.org.

10Centre Georges-François Leclerc, Department of Radiation Oncology, Dijon, France. Electronic address: PMaingon@cgfl.fr.

11Leiden University Medical Center, Department of Radiation Oncology, The Netherlands. Electronic address: c.a.m.marijnen@lumc.nl.

12Peter MacCallum Cancer Centre, Division of Radiation Oncology and Cancer Imaging, Melbourne, Australia. Electronic address: Sam.Ngan@petermac.org.

13KU Leuven - University of Leuven, Department of Oncology and University Hospitals Leuven, Radiation Oncology, Belgium. Electronic address: karin.haustermans@uz.kuleuven.ac.be.