Hiral P Fontanilla1, Ann H Klopp2, Mary E Lindberg3, Anuja Jhingran1, Patrick Kelly1, Vinita Takiar1, Revathy B Iyer4, Charles F Levenback5, Yongbin Zhang3, Lei Dong3, Patricia J Eifel1. 1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 2. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: aklopp@mdanderson.org. 3. Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas. 4. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 5. Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Abstract
PURPOSE: Current information about the anatomic distribution of lymph node (LN) metastases from cervical cancer is not precise enough for optimal treatment planning for highly conformal radiation therapy. To accurately define the anatomic distribution of these LN metastases, we mapped [(18)F] fluorodeoxyglucose positron emission tomography (FDG PET)-positive LNs from 50 women with cervical cancer. METHODS AND MATERIALS: Records of patients with cervical cancer treated from 2006 to 2010 who had pretreatment PET/computed tomography (CT) scans available were retrospectively reviewed. Forty-one consecutive patients (group 1) with FDG-avid LNs were identified; because there were few positive paraortic LNs in group 1, 9 additional patients (group 2) with positive paraortic LNs were added. Involved LNs were contoured on individual PET/CT images, mapped to a template CT scan by deformable image registration, and edited as necessary by a diagnostic radiologist and radiation oncologists to most accurately represent the location on the original PET/CT scan. RESULTS: We identified 190 FDG-avid LNs, 122 in group 1 and 68 in group 2. The highest concentrations of FDG-avid nodes were in the external iliac, common iliac, and paraortic regions. The anatomic distribution of the 122 positive LNs in group 1 was as follows: external iliac, 78 (63.9%); common iliac, 21 (17.2%); paraortic, 9 (7.4%); internal iliac, 8 (6.6%); presacral, 2 (1.6%); perirectal, 2 (1.6%); and medial inguinal, 2 (1.6%). Twelve pelvic LNs were not fully covered when the clinical target volume was defined according to Radiation Therapy Oncology Group guidelines for intensity modulated radiation therapy for cervical cancer. CONCLUSIONS: Our findings clarify nodal volumes at risk and can be used to improve target definition in conformal radiation therapy for cervical cancer. Our findings suggest several areas that may not be adequately covered by contours described in available atlases.
PURPOSE: Current information about the anatomic distribution of lymph node (LN) metastases from cervical cancer is not precise enough for optimal treatment planning for highly conformal radiation therapy. To accurately define the anatomic distribution of these LN metastases, we mapped [(18)F] fluorodeoxyglucose positron emission tomography (FDG PET)-positive LNs from 50 women with cervical cancer. METHODS AND MATERIALS: Records of patients with cervical cancer treated from 2006 to 2010 who had pretreatment PET/computed tomography (CT) scans available were retrospectively reviewed. Forty-one consecutive patients (group 1) with FDG-avid LNs were identified; because there were few positive paraortic LNs in group 1, 9 additional patients (group 2) with positive paraortic LNs were added. Involved LNs were contoured on individual PET/CT images, mapped to a template CT scan by deformable image registration, and edited as necessary by a diagnostic radiologist and radiation oncologists to most accurately represent the location on the original PET/CT scan. RESULTS: We identified 190 FDG-avid LNs, 122 in group 1 and 68 in group 2. The highest concentrations of FDG-avid nodes were in the external iliac, common iliac, and paraortic regions. The anatomic distribution of the 122 positive LNs in group 1 was as follows: external iliac, 78 (63.9%); common iliac, 21 (17.2%); paraortic, 9 (7.4%); internal iliac, 8 (6.6%); presacral, 2 (1.6%); perirectal, 2 (1.6%); and medial inguinal, 2 (1.6%). Twelve pelvic LNs were not fully covered when the clinical target volume was defined according to Radiation Therapy Oncology Group guidelines for intensity modulated radiation therapy for cervical cancer. CONCLUSIONS: Our findings clarify nodal volumes at risk and can be used to improve target definition in conformal radiation therapy for cervical cancer. Our findings suggest several areas that may not be adequately covered by contours described in available atlases.
Authors: 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 Journal: Int J Radiat Oncol Biol Phys Date: 2010-05-14 Impact factor: 7.038
Authors: Beth M Beadle; Anuja Jhingran; Sue S Yom; Pedro T Ramirez; Patricia J Eifel Journal: Int J Radiat Oncol Biol Phys Date: 2009-07-04 Impact factor: 7.038
Authors: Jason D Wright; Farrokh Dehdashti; Thomas J Herzog; David G Mutch; Phyllis C Huettner; Janet S Rader; Randall K Gibb; Matthew A Powell; Feng Gao; Barry A Siegel; Perry W Grigsby Journal: Cancer Date: 2005-12-01 Impact factor: 6.860
Authors: He Wang; Lei Dong; Jennifer O'Daniel; Radhe Mohan; Adam S Garden; K Kian Ang; Deborah A Kuban; Mark Bonnen; Joe Y Chang; Rex Cheung Journal: Phys Med Biol Date: 2005-06-01 Impact factor: 3.609
Authors: J C Roeske; A Lujan; J Rotmensch; S E Waggoner; D Yamada; A J Mundt Journal: Int J Radiat Oncol Biol Phys Date: 2000-12-01 Impact factor: 7.038
Authors: Robert Dinniwell; Philip Chan; Gregory Czarnota; Masoom A Haider; Kartik Jhaveri; Michael Jewett; Anthony Fyles; David Jaffray; Michael Milosevic Journal: Int J Radiat Oncol Biol Phys Date: 2008-12-25 Impact factor: 7.038
Authors: Patricia J Eifel; Kathryn Winter; Mitchell Morris; Charles Levenback; Perry W Grigsby; Jay Cooper; Marvin Rotman; David Gershenson; David G Mutch Journal: J Clin Oncol Date: 2004-03-01 Impact factor: 44.544
Authors: Rachel B Ger; Jinzhong Yang; Yao Ding; Megan C Jacobsen; Clifton D Fuller; Rebecca M Howell; Heng Li; R Jason Stafford; Shouhao Zhou; Laurence E Court Journal: Med Phys Date: 2017-07-18 Impact factor: 4.071
Authors: Judit A Adam; Annika Loft; Cyrus Chargari; Roberto C Delgado Bolton; Elisabeth Kidd; Heiko Schöder; Patrick Veit-Haibach; Wouter V Vogel Journal: Eur J Nucl Med Mol Imaging Date: 2020-12-04 Impact factor: 9.236