Department of Radiation Oncology, University Hospital Magdeburg, Germany.
KU Leuven, Radiation Oncology, Belgium.
Radiother Oncol. 2021 Jan;154:60-69. doi: 10.1016/j.radonc.2020.07.052. Epub 2020 Aug 28.
Despite of the predominant role of chemotherapy and surgery in pancreatic ductal adenocarcinoma (PDAC), radiotherapy (RT) still has a place in multimodal management of this disease where local tumour sequelae are fatal in about 40% of the patients. RT (chemoradiotherapy and stereotactic body radiotherapy) is used and investigated in the non-metastatic setting as part of definitive treatment strategies, in (neo)adjuvant settings and for locally recurrent disease. The ACROP committee was delegated by ESTRO to recommend target volume delineation for these clinical situations. The guidelines of this document are a result of a structured evaluation of the best available evidence by a panel of international experts in the field. Guidance for treatment planning including diagnostic imaging is provided. Recommendations are given for GTV delineation. The role and the definition of CTV volumes are critically discussed. Aspects of motion management and patient positioning are taken into account for PTV definition. Furthermore, aspects of delineation of organs at risk and of dose constraints are described in both, standard and hypofractionated, settings. This guideline has the purpose to support standardised and optimised processes of RT treatment planning for both, clinical practice and prospective studies.
尽管化疗和手术在胰腺导管腺癌（PDAC）中起主要作用，但放疗（RT）在该疾病的多模式管理中仍占有一席之地，约 40%的患者因局部肿瘤后遗症而死亡。RT（放化疗和立体定向体部放疗）在非转移性环境中被用作确定性治疗策略的一部分，在（新）辅助环境中和局部复发性疾病中被使用和研究。ESTRO 委托 ACROP 委员会推荐这些临床情况下的靶区勾画。本文件的指南是由该领域的一组国际专家对最佳可用证据进行结构化评估的结果。提供了治疗计划（包括诊断成像）的指导。对 GTV 勾画提出了建议。CTV 体积的作用和定义受到严格讨论。在 PTV 定义中考虑了运动管理和患者定位的方面。此外，在标准和超分割设置中，还描述了危及器官的勾画和剂量限制的方面。本指南旨在支持 RT 治疗计划的标准化和优化过程，既适用于临床实践，也适用于前瞻性研究。
