Development of a consensus-based delineation guideline for locally recurrent rectal cancer
(2022) In Radiotherapy and Oncology 177. p.214-221- Abstract
Background and purpose: Neoadjuvant chemoradiotherapy (nCRT) is used in locally recurrent rectal cancer (LRRC) to increase chances of a radical surgical resection. Delineation in LRRC is hampered by complex disease presentation and limited clinical exposure. Within the PelvEx II trial, evaluating the benefit of chemotherapy preceding nCRT for LRRC, a delineation guideline was developed by an expert LRRC team. Materials and methods: Eight radiation oncologists, from Dutch and Swedish expert centres, participated in two meetings, delineating GTV and CTV in six cases. Regions at-risk for re-recurrence or irradical resection were identified by eleven expert surgeons and one expert radiologist. Target volumes were evaluated... (More)
Background and purpose: Neoadjuvant chemoradiotherapy (nCRT) is used in locally recurrent rectal cancer (LRRC) to increase chances of a radical surgical resection. Delineation in LRRC is hampered by complex disease presentation and limited clinical exposure. Within the PelvEx II trial, evaluating the benefit of chemotherapy preceding nCRT for LRRC, a delineation guideline was developed by an expert LRRC team. Materials and methods: Eight radiation oncologists, from Dutch and Swedish expert centres, participated in two meetings, delineating GTV and CTV in six cases. Regions at-risk for re-recurrence or irradical resection were identified by eleven expert surgeons and one expert radiologist. Target volumes were evaluated multidisciplinary. Inter-observer variation was analysed. Results: Inter-observer variation in delineation of LRRC appeared large. Multidisciplinary evaluation per case is beneficial in determining target volumes. The following consensus regarding target volumes was reached. GTV should encompass all tumour, including extension into OAR if applicable. If the tumour is in fibrosis, GTV should encompass the entire fibrotic area. Only if tumour can clearly be distinguished from fibrosis, GTV may be reduced, as long as the entire fibrotic area is covered by the CTV. CTV is GTV with a 1 cm margin and should encompass all at-risk regions for irradical resection or re-recurrence. CTV should not be adjusted towards other organs. Multifocal recurrences should be encompassed in one CTV. Elective nodal delineation is only advised in radiotherapy-naïve patients. Conclusion: This study provides a first consensus-based delineation guideline for LRRC. Analyses of re-recurrences is needed to understand disease behaviour and to optimize delineation guidelines accordingly.
(Less)
- author
- publishing date
- 2022-12
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Consensus-based, Delineation guideline, Inter-observer variation, Locally recurrent rectal cancer, Multidisciplinary target volume definition, Re-irradiation
- in
- Radiotherapy and Oncology
- volume
- 177
- pages
- 8 pages
- publisher
- Elsevier
- external identifiers
-
- pmid:36410547
- scopus:85142775297
- ISSN
- 0167-8140
- DOI
- 10.1016/j.radonc.2022.11.008
- language
- English
- LU publication?
- no
- additional info
- Funding Information: Special thanks to K. Havenga J. Melenhorst A.G.J. Aalbers E. Angenete, M.L. Lydrup, P. Nilsson, P. Buchwald, J.E. Frödin and H. Iversen for participating in the discussion leading to the consensus guideline. ZonMw (10070012010003) and Dutch Cancer Society (2020-1/12960) funded the PelvEx II trial. The funding sources had no role in study design, data collection, data analysis, data interpretation, or writing the paper. Publisher Copyright: © 2022 Elsevier B.V.
- id
- e1c915cf-7644-4e80-8471-8a41dc4a5929
- date added to LUP
- 2022-12-23 09:36:01
- date last changed
- 2024-04-16 18:26:13
@article{e1c915cf-7644-4e80-8471-8a41dc4a5929,
abstract = {{<p>Background and purpose: Neoadjuvant chemoradiotherapy (nCRT) is used in locally recurrent rectal cancer (LRRC) to increase chances of a radical surgical resection. Delineation in LRRC is hampered by complex disease presentation and limited clinical exposure. Within the PelvEx II trial, evaluating the benefit of chemotherapy preceding nCRT for LRRC, a delineation guideline was developed by an expert LRRC team. Materials and methods: Eight radiation oncologists, from Dutch and Swedish expert centres, participated in two meetings, delineating GTV and CTV in six cases. Regions at-risk for re-recurrence or irradical resection were identified by eleven expert surgeons and one expert radiologist. Target volumes were evaluated multidisciplinary. Inter-observer variation was analysed. Results: Inter-observer variation in delineation of LRRC appeared large. Multidisciplinary evaluation per case is beneficial in determining target volumes. The following consensus regarding target volumes was reached. GTV should encompass all tumour, including extension into OAR if applicable. If the tumour is in fibrosis, GTV should encompass the entire fibrotic area. Only if tumour can clearly be distinguished from fibrosis, GTV may be reduced, as long as the entire fibrotic area is covered by the CTV. CTV is GTV with a 1 cm margin and should encompass all at-risk regions for irradical resection or re-recurrence. CTV should not be adjusted towards other organs. Multifocal recurrences should be encompassed in one CTV. Elective nodal delineation is only advised in radiotherapy-naïve patients. Conclusion: This study provides a first consensus-based delineation guideline for LRRC. Analyses of re-recurrences is needed to understand disease behaviour and to optimize delineation guidelines accordingly.</p>}},
author = {{Piqeur, Floor and Hupkens, Britt J.P. and Nordkamp, Stefi and Witte, Marnix G. and Meijnen, Philip and Ceha, Heleen M. and Berbee, Maaike and Dieters, Margriet and Heyman, Sofia and Valdman, Alexander and Nilsson, Martin P. and Nederend, Joost and Rutten, Harm J.T. and Burger, Jacobus W.A. and Marijnen, Corrie A.M. and Peulen, Heike M.U.}},
issn = {{0167-8140}},
keywords = {{Consensus-based; Delineation guideline; Inter-observer variation; Locally recurrent rectal cancer; Multidisciplinary target volume definition; Re-irradiation}},
language = {{eng}},
pages = {{214--221}},
publisher = {{Elsevier}},
series = {{Radiotherapy and Oncology}},
title = {{Development of a consensus-based delineation guideline for locally recurrent rectal cancer}},
url = {{http://dx.doi.org/10.1016/j.radonc.2022.11.008}},
doi = {{10.1016/j.radonc.2022.11.008}},
volume = {{177}},
year = {{2022}},
}