Nordic anal cancer (NOAC) group consensus guidelines for risk-adapted delineation of the elective clinical target volume in anal cancer
(2023) In Acta Oncologica 62(8). p.897-906- Abstract
Background: To date, anal cancer patients are treated with radiotherapy to similar volumes despite a marked difference in risk profile based on tumor location and stage. A more individualized approach to delineation of the elective clinical target volume (CTVe) could potentially provide better oncological outcomes as well as improved quality of life. The aim of the present work was to establish Nordic Anal Cancer (NOAC) group guidelines for delineation of the CTVe in anal cancer. Methods: First, 12 radiation oncologists reviewed the literature in one of the following four areas: (1) previous delineation guidelines; (2) patterns of recurrence; (3) anatomical studies; (4) common iliac and para-aortic recurrences and delineation... (More)
Background: To date, anal cancer patients are treated with radiotherapy to similar volumes despite a marked difference in risk profile based on tumor location and stage. A more individualized approach to delineation of the elective clinical target volume (CTVe) could potentially provide better oncological outcomes as well as improved quality of life. The aim of the present work was to establish Nordic Anal Cancer (NOAC) group guidelines for delineation of the CTVe in anal cancer. Methods: First, 12 radiation oncologists reviewed the literature in one of the following four areas: (1) previous delineation guidelines; (2) patterns of recurrence; (3) anatomical studies; (4) common iliac and para-aortic recurrences and delineation guidelines. Second, areas of controversy were identified and discussed with the aim of reaching consensus. Results: We present consensus-based recommendations for CTVe delineation in anal cancer regarding (a) which regions to include, and (b) how the regions should be delineated. Some of our recommendations deviate from current international guidelines. For instance, the posterolateral part of the inguinal region is excluded, decreasing the volume of irradiated normal tissue. For the external iliac region and the cranial border of the CTVe, we agreed on specifying two different recommendations, both considered acceptable. One of these recommendations is novel and risk-adapted; the external iliac region is omitted for low-risk patients, and several different cranial borders are used depending on the individual level of risk. Conclusion: We present NOAC consensus guidelines for delineation of the CTVe in anal cancer, including a risk-adapted strategy.
(Less)
- author
- organization
- publishing date
- 2023
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Anal carcinoma, common iliac, contouring, delineation, para-aortic
- in
- Acta Oncologica
- volume
- 62
- issue
- 8
- pages
- 10 pages
- publisher
- Taylor & Francis
- external identifiers
-
- pmid:37504978
- scopus:85172425805
- ISSN
- 0284-186X
- DOI
- 10.1080/0284186X.2023.2240490
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
- id
- bc008cde-e78e-4c1c-9394-b89f39b16fc2
- date added to LUP
- 2024-01-03 10:42:03
- date last changed
- 2024-04-18 08:01:24
@article{bc008cde-e78e-4c1c-9394-b89f39b16fc2,
abstract = {{<p>Background: To date, anal cancer patients are treated with radiotherapy to similar volumes despite a marked difference in risk profile based on tumor location and stage. A more individualized approach to delineation of the elective clinical target volume (CTVe) could potentially provide better oncological outcomes as well as improved quality of life. The aim of the present work was to establish Nordic Anal Cancer (NOAC) group guidelines for delineation of the CTVe in anal cancer. Methods: First, 12 radiation oncologists reviewed the literature in one of the following four areas: (1) previous delineation guidelines; (2) patterns of recurrence; (3) anatomical studies; (4) common iliac and para-aortic recurrences and delineation guidelines. Second, areas of controversy were identified and discussed with the aim of reaching consensus. Results: We present consensus-based recommendations for CTVe delineation in anal cancer regarding (a) which regions to include, and (b) how the regions should be delineated. Some of our recommendations deviate from current international guidelines. For instance, the posterolateral part of the inguinal region is excluded, decreasing the volume of irradiated normal tissue. For the external iliac region and the cranial border of the CTVe, we agreed on specifying two different recommendations, both considered acceptable. One of these recommendations is novel and risk-adapted; the external iliac region is omitted for low-risk patients, and several different cranial borders are used depending on the individual level of risk. Conclusion: We present NOAC consensus guidelines for delineation of the CTVe in anal cancer, including a risk-adapted strategy.</p>}},
author = {{Nilsson, Martin P. and Undseth, Christine and Albertsson, Per and Eidem, Monika and Havelund, Birgitte Mayland and Johannsson, Jakob and Johnsson, Anders and Radu, Calin and Serup-Hansen, Eva and Spindler, Karen Lise and Zakrisson, Björn and Guren, Marianne G. and Kronborg, Camilla}},
issn = {{0284-186X}},
keywords = {{Anal carcinoma; common iliac; contouring; delineation; para-aortic}},
language = {{eng}},
number = {{8}},
pages = {{897--906}},
publisher = {{Taylor & Francis}},
series = {{Acta Oncologica}},
title = {{Nordic anal cancer (NOAC) group consensus guidelines for risk-adapted delineation of the elective clinical target volume in anal cancer}},
url = {{http://dx.doi.org/10.1080/0284186X.2023.2240490}},
doi = {{10.1080/0284186X.2023.2240490}},
volume = {{62}},
year = {{2023}},
}