Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy for the definitive treatment of cervix cancer

Karen Lim, William Small, Lorraine Portelance, Carien Creutzberg, Ina M. Jürgenliemk-Schulz, Arno Mundt, Loren K. Mell, Nina Mayr, Akila Viswanathan, Anuja Jhingran, Beth Erickson, Jennifer De Los Santos, David Gaffney, Catheryn Yashar, Sushil Beriwal, Aaron Wolfson, Alexandra Taylor, Walter Bosch, Issam El Naqa, Anthony Fyles

Research output: Contribution to journalArticle

Abstract

Purpose: Accurate target definition is vitally important for definitive treatment of cervix cancer with intensity-modulated radiotherapy (IMRT), yet a definition of clinical target volume (CTV) remains variable within the literature. The aim of this study was to develop a consensus CTV definition in preparation for a Phase 2 clinical trial being planned by the Radiation Therapy Oncology Group. Methods and Materials: A guidelines consensus working group meeting was convened in June 2008 for the purposes of developing target definition guidelines for IMRT for the intact cervix. A draft document of recommendations for CTV definition was created and used to aid in contouring a clinical case. The clinical case was then analyzed for consistency and clarity of target delineation using an expectation maximization algorithm for simultaneous truth and performance level estimation (STAPLE), with kappa statistics as a measure of agreement between participants. Results: Nineteen experts in gynecological radiation oncology generated contours on axial magnetic resonance images of the pelvis. Substantial STAPLE agreement sensitivity and specificity values were seen for gross tumor volume (GTV) delineation (0.84 and 0.96, respectively) with a kappa statistic of 0.68 (p < 0.0001). Agreement for delineation of cervix, uterus, vagina, and parametria was moderate. Conclusions: This report provides guidelines for CTV definition in the definitive cervix cancer setting for the purposes of IMRT, building on previously published guidelines for IMRT in the postoperative setting.

Original languageEnglish (US)
Pages (from-to)348-355
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume79
Issue number2
DOIs
StatePublished - Feb 1 2011
Externally publishedYes

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Intensity-Modulated Radiotherapy
delineation
Uterine Cervical Neoplasms
radiation therapy
Consensus
cancer
Guidelines
Radiation Oncology
Cervix Uteri
Group Processes
Peritoneum
Vagina
Therapeutics
Tumor Burden
Pelvis
statistics
Magnetic Resonance Spectroscopy
Radiotherapy
uterus
Clinical Trials

Keywords

  • Cervical cancer
  • CTV
  • Guidelines
  • Intensity-modulated radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy for the definitive treatment of cervix cancer. / Lim, Karen; Small, William; Portelance, Lorraine; Creutzberg, Carien; Jürgenliemk-Schulz, Ina M.; Mundt, Arno; Mell, Loren K.; Mayr, Nina; Viswanathan, Akila; Jhingran, Anuja; Erickson, Beth; De Los Santos, Jennifer; Gaffney, David; Yashar, Catheryn; Beriwal, Sushil; Wolfson, Aaron; Taylor, Alexandra; Bosch, Walter; El Naqa, Issam; Fyles, Anthony.

In: International Journal of Radiation Oncology Biology Physics, Vol. 79, No. 2, 01.02.2011, p. 348-355.

Research output: Contribution to journalArticle

Lim, K, Small, W, Portelance, L, Creutzberg, C, Jürgenliemk-Schulz, IM, Mundt, A, Mell, LK, Mayr, N, Viswanathan, A, Jhingran, A, Erickson, B, De Los Santos, J, Gaffney, D, Yashar, C, Beriwal, S, Wolfson, A, Taylor, A, Bosch, W, El Naqa, I & Fyles, A 2011, 'Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy for the definitive treatment of cervix cancer', International Journal of Radiation Oncology Biology Physics, vol. 79, no. 2, pp. 348-355. https://doi.org/10.1016/j.ijrobp.2009.10.075
Lim, Karen ; Small, William ; Portelance, Lorraine ; Creutzberg, Carien ; Jürgenliemk-Schulz, Ina M. ; Mundt, Arno ; Mell, Loren K. ; Mayr, Nina ; Viswanathan, Akila ; Jhingran, Anuja ; Erickson, Beth ; De Los Santos, Jennifer ; Gaffney, David ; Yashar, Catheryn ; Beriwal, Sushil ; Wolfson, Aaron ; Taylor, Alexandra ; Bosch, Walter ; El Naqa, Issam ; Fyles, Anthony. / Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy for the definitive treatment of cervix cancer. In: International Journal of Radiation Oncology Biology Physics. 2011 ; Vol. 79, No. 2. pp. 348-355.
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AU - Creutzberg, Carien

AU - Jürgenliemk-Schulz, Ina M.

AU - Mundt, Arno

AU - Mell, Loren K.

AU - Mayr, Nina

AU - Viswanathan, Akila

AU - Jhingran, Anuja

AU - Erickson, Beth

AU - De Los Santos, Jennifer

AU - Gaffney, David

AU - Yashar, Catheryn

AU - Beriwal, Sushil

AU - Wolfson, Aaron

AU - Taylor, Alexandra

AU - Bosch, Walter

AU - El Naqa, Issam

AU - Fyles, Anthony

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