H D Heerkens1, W A Hall2, X A Li2, P Knechtges3, E Dalah4, E S Paulson2, C A T van den Berg1, G J Meijer1, E J Koay5, C H Crane5, K Aitken6, M van Vulpen1, B A Erickson7. 1. Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands. 2. Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin. 3. Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin. 4. Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin; Medical Diagnostic Imaging Department, College of Health and Science, University of Sharjah, Sharjah, Dubai. 5. Department of Radiation Oncology, MD Anderson Hospital, Houston, Texas. 6. Department of Radiation Oncology, Royal Marsden Hospital London, England. 7. Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: berickson@mcw.edu.
Abstract
PURPOSE: Local recurrence is a common and morbid event in patients with unresectable pancreatic adenocarcinoma. A more conformal and targeted radiation dose to the macroscopic tumor in nonmetastatic pancreatic cancer is likely to reduce acute toxicity and improve local control. Optimal soft tissue contrast is required to facilitate delineation of a target and creation of a planning target volume with margin reduction and motion management. Magnetic resonance imaging (MRI) offers considerable advantages in optimizing soft tissue delineation and is an ideal modality for imaging and delineating a gross tumor volume (GTV) within the pancreas, particularly as it relates to conformal radiation planning. Currently, no guidelines have been defined for the delineation of pancreatic tumors for radiation therapy treatment planning. Moreover, abdominal MRI sequences are complex and the anatomy relevant to the radiation oncologist can be challenging. The purpose of this study is to provide recommendations for delineation of GTV and organs at risk (OARs) using MRI and incorporating multiple MRI sequences. METHODS AND MATERIALS: Five patients with pancreatic cancer and 1 healthy subject were imaged with MRI scans either on 1.5T or on 3T magnets in 2 separate institutes. The GTV and OARs were contoured for all patients in a consensus meeting. RESULTS: An overview of MRI-based anatomy of the GTV and OARs is provided. Practical contouring instructions for the GTV and the OARs with the aid of MRI were developed and included in these recommendations. In addition, practical suggestions for implementation of MRI in pancreatic radiation treatment planning are provided. CONCLUSIONS: With this report, we attempt to provide recommendations for MRI-based contouring of pancreatic tumors and OARs. This could lead to better uniformity in defining the GTV and OARs for clinical trials and in radiation therapy treatment planning, with the ultimate goal of improving local control while minimizing morbidity.
PURPOSE: Local recurrence is a common and morbid event in patients with unresectable pancreatic adenocarcinoma. A more conformal and targeted radiation dose to the macroscopic tumor in nonmetastatic pancreatic cancer is likely to reduce acute toxicity and improve local control. Optimal soft tissue contrast is required to facilitate delineation of a target and creation of a planning target volume with margin reduction and motion management. Magnetic resonance imaging (MRI) offers considerable advantages in optimizing soft tissue delineation and is an ideal modality for imaging and delineating a gross tumor volume (GTV) within the pancreas, particularly as it relates to conformal radiation planning. Currently, no guidelines have been defined for the delineation of pancreatic tumors for radiation therapy treatment planning. Moreover, abdominal MRI sequences are complex and the anatomy relevant to the radiation oncologist can be challenging. The purpose of this study is to provide recommendations for delineation of GTV and organs at risk (OARs) using MRI and incorporating multiple MRI sequences. METHODS AND MATERIALS: Five patients with pancreatic cancer and 1 healthy subject were imaged with MRI scans either on 1.5T or on 3T magnets in 2 separate institutes. The GTV and OARs were contoured for all patients in a consensus meeting. RESULTS: An overview of MRI-based anatomy of the GTV and OARs is provided. Practical contouring instructions for the GTV and the OARs with the aid of MRI were developed and included in these recommendations. In addition, practical suggestions for implementation of MRI in pancreatic radiation treatment planning are provided. CONCLUSIONS: With this report, we attempt to provide recommendations for MRI-based contouring of pancreatic tumors and OARs. This could lead to better uniformity in defining the GTV and OARs for clinical trials and in radiation therapy treatment planning, with the ultimate goal of improving local control while minimizing morbidity.
Authors: Patrick J Boyle; Elizabeth Huynh; Sara Boyle; Jennifer Campbell; Jessica Penney; Iquan Usta; Emily Neubauer Sugar; Fred Hacker; Christopher Williams; Daniel Cagney; Raymond Mak; Lisa Singer Journal: Tech Innov Patient Support Radiat Oncol Date: 2020-11-29
Authors: Sven Olberg; Olga Green; Bin Cai; Deshan Yang; Vivian Rodriguez; Hao Zhang; Jin Sung Kim; Parag J Parikh; Sasa Mutic; Justin C Park Journal: Radiat Oncol Date: 2018-03-24 Impact factor: 3.481
Authors: Stefan Weick; Kathrin Breuer; Anne Richter; Florian Exner; Serge-Peer Ströhle; Paul Lutyj; Jörg Tamihardja; Simon Veldhoen; Michael Flentje; Bülent Polat Journal: BMC Med Imaging Date: 2020-04-23 Impact factor: 1.930
Authors: Oliver J Gurney-Champion; David J Collins; Andreas Wetscherek; Mihaela Rata; Remy Klaassen; Hanneke W M van Laarhoven; Kevin J Harrington; Uwe Oelfke; Matthew R Orton Journal: Phys Med Biol Date: 2019-05-17 Impact factor: 3.609
Authors: Maureen Lee; Anna Simeonov; Teo Stanescu; Laura A Dawson; Kristy K Brock; Michael Velec Journal: J Appl Clin Med Phys Date: 2021-01-15 Impact factor: 2.102
Authors: William A Hall; Christina Small; Eric Paulson; Eugene J Koay; Christopher Crane; Martijn Intven; Lois A Daamen; Gert J Meijer; Hanne D Heerkens; Michael Bassetti; Stephen A Rosenberg; Katharine Aitken; Sten Myrehaug; Laura A Dawson; Percy Lee; Cihan Gani; Michael David Chuong; Parag J Parikh; Beth A Erickson Journal: Front Oncol Date: 2021-05-11 Impact factor: 5.738
Authors: Sophie E Vollenbrock; Marlies E Nowee; Francine E M Voncken; Alexis N T J Kotte; Lucas Goense; Peter S N van Rossum; Astrid L H M W van Lier; Stijn W Heijmink; Annemarieke Bartels-Rutten; Frank J Wessels; Berthe M P Aleman; Luc Dewit; Linda G W Kerkmeijer; Edwin P M Jansen; Martijn Intven; Irene M Lips; Gert J Meijer; Jasper Nijkamp Journal: Adv Radiat Oncol Date: 2019-04-24