William A Hall1, Eric Paulson2, Brian J Davis3, Daniel E Spratt4, Todd M Morgan5, David Dearnaley6, Alison C Tree6, Jason A Efstathiou7, Mukesh Harisinghani8, Ashesh B Jani9, Mark K Buyyounouski10, Thomas M Pisansky3, Phuoc T Tran11, R Jeffrey Karnes12, Ronald C Chen13, Fabio L Cury14, Jeff M Michalski15, Seth A Rosenthal16, Bridget F Koontz17, Anthony C Wong18, Paul L Nguyen19, Thomas A Hope20, Felix Feng18, Howard M Sandler21, Colleen A F Lawton2. 1. Medical College of Wisconsin, Department of Radiation Oncology, Milwaukee, Wisconsin. Electronic address: whall@mcw.edu. 2. Medical College of Wisconsin, Department of Radiation Oncology, Milwaukee, Wisconsin. 3. Mayo Clinic, Department of Radiation Oncology, Rochester, Minnesota. 4. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan. 5. Department of Urology, University of Michigan, Ann Arbor, Michigan. 6. The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, UK. 7. Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts. 8. Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts. 9. Department of Radiation Oncology, Emory University, Atlanta, Georgia. 10. Department of Radiation Oncology, Stanford University, Stanford, California. 11. Department of Radiation Oncology, Johns Hopkins, Baltimore, Maryland. 12. Department of Urology, Mayo Clinic, Rochester, Minnesota. 13. Department of Radiation Oncology, University of Kansas, Kansas City, Kansas. 14. Department of Radiation Oncology, McGill University, Montreal, Canada. 15. Department of Radiation Oncology, Washington University, St. Louis, Missouri. 16. Department of Radiation Oncology, Sutter Medical Group, Roseville, California. 17. Department of Radiation Oncology, Duke Cancer Institute, Durham, North Carolina. 18. Department of Radiation Oncology, University of California San Francisco, San Francisco, California. 19. Department of Radiation Oncology, Dana Farber Harvard Cancer Center, Boston, Massachusetts. 20. Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California. 21. Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California.
Abstract
PURPOSE: In 2009, the Radiation Therapy Oncology Group (RTOG) genitourinary members published a consensus atlas for contouring prostate pelvic nodal clinical target volumes (CTVs). Data have emerged further informing nodal recurrence patterns. The objective of this study is to provide an updated prostate pelvic nodal consensus atlas. METHODS AND MATERIALS: A literature review was performed abstracting data on nodal recurrence patterns. Data were presented to a panel of international experts, including radiation oncologists, radiologists, and urologists. After data review, participants contoured nodal CTVs on 3 cases: postoperative, intact node positive, and intact node negative. Radiation oncologist contours were analyzed qualitatively using count maps, which provided a visual assessment of controversial regions, and quantitatively analyzed using Sorensen-Dice similarity coefficients and Hausdorff distances compared with the 2009 RTOG atlas. Diagnostic radiologists generated a reference table outlining considerations for determining clinical node positivity. RESULTS: Eighteen radiation oncologists' contours (54 CTVs) were included. Two urologists' volumes were examined in a separate analysis. The mean CTV for the postoperative case was 302 cm3, intact node positive case was 409 cm3, and intact node negative case was 342 cm3. Compared with the original RTOG consensus, the mean Sorensen-Dice similarity coefficient for the postoperative case was 0.63 (standard deviation [SD] 0.13), the intact node positive case was 0.68 (SD 0.13), and the intact node negative case was 0.66 (SD 0.18). The mean Hausdorff distance (in cm) for the postoperative case was 0.24 (SD 0.13), the intact node positive case was 0.23 (SD 0.09), and intact node negative case was 0.33 (SD 0.24). Four regions of CTV controversy were identified, and consensus for each of these areas was reached. CONCLUSIONS: Discordance with the 2009 RTOG consensus atlas was seen in a group of experienced NRG Oncology and international genitourinary radiation oncologists. To address areas of variability and account for new data, an updated NRG Oncology consensus contour atlas was developed.
PURPOSE: In 2009, the Radiation Therapy Oncology Group (RTOG) genitourinary members published a consensus atlas for contouring prostate pelvic nodal clinical target volumes (CTVs). Data have emerged further informing nodal recurrence patterns. The objective of this study is to provide an updated prostate pelvic nodal consensus atlas. METHODS AND MATERIALS: A literature review was performed abstracting data on nodal recurrence patterns. Data were presented to a panel of international experts, including radiation oncologists, radiologists, and urologists. After data review, participants contoured nodal CTVs on 3 cases: postoperative, intact node positive, and intact node negative. Radiation oncologist contours were analyzed qualitatively using count maps, which provided a visual assessment of controversial regions, and quantitatively analyzed using Sorensen-Dice similarity coefficients and Hausdorff distances compared with the 2009 RTOG atlas. Diagnostic radiologists generated a reference table outlining considerations for determining clinical node positivity. RESULTS: Eighteen radiation oncologists' contours (54 CTVs) were included. Two urologists' volumes were examined in a separate analysis. The mean CTV for the postoperative case was 302 cm3, intact node positive case was 409 cm3, and intact node negative case was 342 cm3. Compared with the original RTOG consensus, the mean Sorensen-Dice similarity coefficient for the postoperative case was 0.63 (standard deviation [SD] 0.13), the intact node positive case was 0.68 (SD 0.13), and the intact node negative case was 0.66 (SD 0.18). The mean Hausdorff distance (in cm) for the postoperative case was 0.24 (SD 0.13), the intact node positive case was 0.23 (SD 0.09), and intact node negative case was 0.33 (SD 0.24). Four regions of CTV controversy were identified, and consensus for each of these areas was reached. CONCLUSIONS: Discordance with the 2009 RTOG consensus atlas was seen in a group of experienced NRG Oncology and international genitourinary radiation oncologists. To address areas of variability and account for new data, an updated NRG Oncology consensus contour atlas was developed.
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