Medical College of Wisconsin, Department of Radiation Oncology, Milwaukee, Wisconsin.
Medical College of Wisconsin, Department of Radiation Oncology, Milwaukee, Wisconsin.
Int J Radiat Oncol Biol Phys. 2021 Jan 1;109(1):174-185. doi: 10.1016/j.ijrobp.2020.08.034. Epub 2020 Aug 27.
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.
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.
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 cm, intact node positive case was 409 cm, and intact node negative case was 342 cm. 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.
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.
2009 年，放射治疗肿瘤学组（RTOG）泌尿生殖系统成员发布了前列腺盆腔淋巴结临床靶区（CTV）的共识图谱。数据的出现进一步说明了淋巴结复发模式。本研究的目的是提供一个更新的前列腺盆腔淋巴结共识图谱。
进行文献复习，提取淋巴结复发模式的数据。将数据提交给一组国际专家，包括放射肿瘤学家、放射科医生和泌尿科医生。在数据审查后，参与者对 3 例患者进行了淋巴结 CTV 勾画：术后、局部淋巴结阳性和局部淋巴结阴性。使用计数图对放射肿瘤学家的轮廓进行定性分析，计数图提供了有争议区域的直观评估，并使用 Sørensen-Dice 相似系数和 Hausdorff 距离与 2009 年 RTOG 图谱进行定量分析。诊断放射科医生生成了一个参考表，概述了确定临床淋巴结阳性的注意事项。
纳入了 18 名放射肿瘤学家的 54 个 CTV 勾画。另一位泌尿科医生的 2 个 CTV 单独进行了分析。术后病例的CTV 平均为 302cm，局部淋巴结阳性病例为 409cm，局部淋巴结阴性病例为 342cm。与原始 RTOG 共识图谱相比，术后病例的平均 Sørensen-Dice 相似系数为 0.63（标准差 [SD] 0.13），局部淋巴结阳性病例为 0.68（SD 0.13），局部淋巴结阴性病例为 0.66（SD 0.18）。术后病例的平均 Hausdorff 距离（cm）为 0.24（SD 0.13），局部淋巴结阳性病例为 0.23（SD 0.09），局部淋巴结阴性病例为 0.33（SD 0.24）。确定了 4 个 CTV 有争议的区域，并就这些区域达成了共识。
NRG Oncology 和国际泌尿生殖系统放射肿瘤学家的一组经验丰富的专家对 2009 年 RTOG 共识图谱存在分歧。为了解决变异性问题并考虑新的数据，开发了一个更新的 NRG Oncology 共识轮廓图谱。
