PuSH - Publication Server of Helmholtz Zentrum München: Have we achieved adequate recommendations for target volume definitions in anal cancer? A PET imaging based patterns of failure analysis in the context of established contouring guidelines.

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Dapper, H.* ; Schiller, K.* ; Münch, S.* ; Peeken, J.C. ; Borm, K.* ; Weber, W.* ; Combs, S.E.

Have we achieved adequate recommendations for target volume definitions in anal cancer? A PET imaging based patterns of failure analysis in the context of established contouring guidelines.

BMC Cancer 19:742 (2019)

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BackgroundThere are different contouring guidelines for the clinical target volume (CTV) in anal cancer (AC) which vary concerning recommendations for radiation margins in different anatomical regions, especially on inguinal site. PET imaging has become more important in primary staging of AC as a very sensitive method to detect lymph node (LN) metastases. Using PET imaging, we evaluated patterns of LN spread, and examined the differences of the respective contouring guidelines on the basis of our results.MethodsWe carried out a retrospective study of thirty-seven AC patients treated with chemoradiation (CRT) who underwent FDG-PET imaging for primary staging in our department between 2011 and 2018. Patients showing PET positive LN were included in this analysis. Using a color code, LN metastases of all patients were delineated on a template with standard anatomy and were divided indicating whether their location was in- or out-field of the standard CTV as recommended by the Radiation Therapy Oncology Group (RTOG), the Australasian Gastrointestinal Trials Group (AGITG) or the British National Guidance (BNG). Furthermore, a detailed analysis of the location of LN of the inguinal region was performed.ResultsTwenty-two out of thirty-seven AC patients with pre-treatment PET imaging had PET positive LN metastases, accumulating to a total of 154 LN. The most commonly affected anatomical region was inguinal (49 LN, 32%). All para-rectal, external/internal iliac, and pre-sacral LN were covered by the recommended CTVs of the three different guidelines. Of forty-nine involved inguinal LN, fourteen (29%), seven (14%) and five (10%) were situated outside of the recommended CTVs by RTOG, AGITG and BNG. Inguinal LN could be located up to 5.7cm inferiorly to the femoral saphenous junction and 2.8cm medial or laterally to the big femoral vessels.ConclusionPelvis-related, various recommendations are largely consistent, and all LN are covered by the recommended CTVs. LN misses appear generally cranially (common iliac or para-aortic) or caudally (inguinal) to the recommended CTVs. The established guidelines differ significantly, particular regarding the inguinal region. Based on our results, we presented our suggestions for CTV definition of the inguinal region. LN involvement of a larger number of patients should be investigated to enable final recommendations.

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Publication type Article: Journal article

Document type Scientific Article

Corresponding Author

Keywords Anal Cancer ; Pet-ct ; Pet-mri ; Radiation Therapy ; Contouring Guidelines ; Target Volume ; Inguinal Contouring Recommendations; Squamous-cell Carcinoma; Prognostic-factors; Chemoradiation; Chemotherapy; Radiotherapy; Cisplatin; Mitomycin

ISSN (print) / ISBN 1471-2407

e-ISSN 1471-2407

Journal BMC Cancer

Quellenangaben Volume: 19, Issue: 1, Article Number: 742

Publisher BioMed Central

Publishing Place Campus, 4 Crinan St, London N1 9xw, England

Non-patent literature Publications

Reviewing status Peer reviewed

Institute(s) Institute of Radiation Medicine (IRM)