Hendrik Dapper1, Gregor Habl1, Christoph Hirche2, Stefan Münch1, Markus Oechsner1, Michael Mayinger1, Christina Sauter1, Stephanie E Combs1,3,4, Daniel Habermehl1,3. 1. a Department of Radiation Oncology , Klinikum Rechts der Isar, TU München , Munich , Germany. 2. b Department for Hand-, Plastic and Rekonstructive Surgery , Burn Centre BG-Trauma Centre Ludwigshafen/RhineBG - Klinik Ludwigshafen, University of Heidelberg , Ludwigshafen , Germany. 3. c Institute for Innovative Radiotherapie (iRT) , Helmholtz Zentrum München , Neuherberg , Germany. 4. d Deutsches Konsortium für Translationale Krebsforschung (DKTK) , Munich , Germany.
Abstract
INTRODUCTION: The ano-inguinal lymphatic drainage (AILD) is located in the subcutaneous adipose tissue of the proximal medial thigh. Findings from fluorescence methods give us new information about anatomical conditions of the AILD. Current contouring guidelines do not advise the inclusion of the 'true' AILD into the clinical target volume (CTV). Aim of this work was the retrospective analysis of the incidental dose to the AILD in an anal cancer (AC) patient cohort who underwent definitive chemoradiation (CRT) therapy with Volumetric Arc Therapy - Intensity Modulated Radiation Therapy (VMAT-IMRT). METHODS: VMAT-IMRT plans of 15 AC patients were analyzed. Based on findings from new fluorescence methods we created a new volume, the expected AILD. The examined dosimetric parameters were the minimal, maximal and mean dose and V10-V50 that were delivered to the AILD, respectively. RESULTS: The median volume of AILD was 1047 cm³. Mean Dmin, Dmax and Dmean were 7.5 Gy, 58.9 Gy and 40.8 Gy for AILD. The clinical relevant dose of 30.0 Gray covered in mean 76% of the volume of the AILD, respectively. CONCLUSIONS: Only 76% of the AILD-volume received at least an expected required treatment dose of 30 Gy incidentally. Concerning the low number of loco-regional relapses in AC patients after definitive CRT one has to balance increased side effects against a rigid oncological-anatomical interpretation of the local lymphatic drainage by including the AILD into the standard CTV.
INTRODUCTION: The ano-inguinal lymphatic drainage (AILD) is located in the subcutaneous adipose tissue of the proximal medial thigh. Findings from fluorescence methods give us new information about anatomical conditions of the AILD. Current contouring guidelines do not advise the inclusion of the 'true' AILD into the clinical target volume (CTV). Aim of this work was the retrospective analysis of the incidental dose to the AILD in an anal cancer (AC) patient cohort who underwent definitive chemoradiation (CRT) therapy with Volumetric Arc Therapy - Intensity Modulated Radiation Therapy (VMAT-IMRT). METHODS: VMAT-IMRT plans of 15 AC patients were analyzed. Based on findings from new fluorescence methods we created a new volume, the expected AILD. The examined dosimetric parameters were the minimal, maximal and mean dose and V10-V50 that were delivered to the AILD, respectively. RESULTS: The median volume of AILD was 1047 cm³. Mean Dmin, Dmax and Dmean were 7.5 Gy, 58.9 Gy and 40.8 Gy for AILD. The clinical relevant dose of 30.0 Gray covered in mean 76% of the volume of the AILD, respectively. CONCLUSIONS: Only 76% of the AILD-volume received at least an expected required treatment dose of 30 Gy incidentally. Concerning the low number of loco-regional relapses in AC patients after definitive CRT one has to balance increased side effects against a rigid oncological-anatomical interpretation of the local lymphatic drainage by including the AILD into the standard CTV.
Authors: Hendrik Dapper; Markus Oechsner; Christoph Hirche; Stefan Münch; Christina Sauter; Kai Borm; Jan C Peeken; Stephanie E Combs; Daniel Habermehl Journal: Radiat Oncol Date: 2018-11-22 Impact factor: 3.481
Authors: Hendrik Dapper; Markus Oechsner; Stefan Münch; Christian Diehl; Jan C Peeken; Kai Borm; Stephanie E Combs Journal: Strahlenther Onkol Date: 2020-02-03 Impact factor: 3.621
Authors: Martin P Nilsson; Erik D Nilsson; Anders Johnsson; Otilia Leon; Adalsteinn Gunnlaugsson; Jonas Scherman Journal: Radiat Oncol Date: 2020-05-27 Impact factor: 3.481