RTOG-前列腺癌靶区勾画指南

OpenAccessOriginalArticlePublished07/18/2013DOI:10.7759/cureus.128Copyright©2013Smithetal.DistributedunderCreativeCommonsCC-BY3.0ComparativeReviewofConsensus-BasedClinicalTargetVolumeDefinitionsforProstateRadiotherapyGrahamSmith,GeorgeRodriguesCorrespondingauthor:GeorgeRodrigues1.DepartmentofEpidemiologyandBiostatistics,WesternUniversity,LondonON,Canada,N6A5C12.DepartmentofOncology,LondonHealthSciencesCentre;SchulichSchoolofMedicine&Dentistry,WesternUniversity,London,Ontario,CACategories:RadiationOncology,Epidemiology&PublicHealth,UrologyKeywords:clinicaltargetvolume,prostatecancer,contouring,guidelines,radiationtherapy,consensusguidelinesHowtocitethisarticleSmithG,RodriguesG(2013-07-1810:50:36UTC)ComparativeReviewofConsensus-BasedClinicalTargetVolumeDefinitionsforProstateRadiotherapy.Cureus5(7):e128.doi:10.7759/cureus.128AbstractBackground:Amajorobstacleinthedeliveryofpostoperativeradiationtherapy(RT)forprostatecancerisaccuratedelineationofthetumortargetsandorgansatrisk.Althoughpostoperativeprostatecancercontouringatlasesarequitecommon,thereisstillnowidelyacceptedcontouringguideline.ThepurposeofthisstudyistocriticallyreviewthevariouspostoperativeprostateRTtreatmentplanningconsensusguidelinesoratlasescurrentlyavailable.Methods:Aliteraturesearchwasconductedusingvariouselectronicdatabaseswiththekeyterms:prostate,contour,planningtumourvolume,clinicaltargetvolume,delineationordefinition,guidelinesoratlas,andradiationoncology.ThesearchwaslimitedtoEnglishpublicationsfromtheyears1985to2011.Results:Atotalofsevenpublicationsrelatingtocontouringguidelinesforpostoperativeprostateradiotherapywereidentified.Therearefourdistinctconsensusguidelinesdevelopedbymajorinstitutions:PrincessMargaretHospital,theAustralianandNewZealandRadiationOncologyGenito-UrinaryGroup,theEuropeanOrganizationforResearchandTreatmentofCancer,andtheRadiationTherapyOncologyGroup.Conclusions:Afterreviewingtheconsensuscontouringguidelinesforpostoperativeprostatecancerradiationtherapythatwereavailableintheliterature,itisclearthattheredisagreementwithregardstowhatanatomicalbordersshouldbeusedfordelineatinganappropriateprostatebedCTV.Additionalstudiescomparingthereproducibilityofthevariousguidelinesaswellastheperformanceoftheseguidelinesonclinicallyimportantoutcomesareneeded.IntroductionPostoperativeradiationtherapy(RT)isindicatedinthetreatmentofpost-prostatectomypatientswithhigh-riskoflocalrecurrence[1].RecentstudieshaveshownRTtobebeneficialfollowingradicalprostatectomyinboththeadjuvantsetting,forpatientswithhigh-riskpathologicalfeatures,suchaspositivesurgicalmarginsandseminalvesicleinvasion[2-8],orassalvageforbiochemicaldiseaserecurrence[9-10].TworandomisedcontrolledtrialssuggestadjuvantRTdirectlyfollowingsurgeryprovidesimprovedprogression-freesurvival,biochemicalrelapse-freesurvival,andlocalcontroloverwatchfulwaitingprotocols[3,11].Althoughalong-termfollow-upofoneofthesetrialsalsosuggeststhatadjuvantRTalsoimprovesmetastasis-freesurvivalandoverallsurvivalcomparedwithobservationalone[2],thereisinsufficientlong-termfollow-updataavailabletoadequatelyassesstheeffectonthesetreatmentoutcomes.AmajorobstacleinthedeliveryofpostoperativeradiationtherapyforprostatecancerisaccuratedelineationofthetumortargetsandOrgansatRisk(OARs).Inter-observervariabilitybetweenoncologistdrawncontoursinprostateradiationtherapyiswelldocumented[12-15]andhasbeenidentifiedasahighlysignificantcontributingfactortouncertaintyinradiationtherapytreatmentplanning[16].ContouringconsensusguidelinesoratlasesforpostoperativeprostateRThavebeencreatedtoaidoncologistsinthedelineationoftumortargetsandOARswiththehopeofreducingthisvariability.Althoughpostoperativeprostatecancercontouringatlasesarequitecommon,thereisstillnowidelyacceptedcontouringguideline.ThepurposeofthisstudyistocriticallyreviewthevariouspostoperativeprostateRTtreatmentplanningconsensusguidelinesoratlasescurrentlyavailablewithemphasesonthemethodologyandvalidityofeachatlas.MaterialsAndMethodsAliteraturesearchwasconductedusingtheelectronicdatabasesPubmed,MEDLINE(OVID),EMBASE,CochraneLibrary,andGoogleScholarwiththekeyterms:prostate,contour,planningtumour2013Smithetal.Cureus5(7):e128.DOI10.7759/cureus.128Page2of19Scholarwiththekeyterms:prostate,contour,planningtumourvolume,clinicaltargetvolume,delineationordefinition,guidelinesoratlas,andradiationoncology.ThesearchwaslimitedtoEnglishpublicationsfromtheyears1985to2011.Relevantstudiesfoundonreferenceslistsofidentifiedarticleswereincludedaswellasanyarticlesfoundonnationalcooperativegroupwebsites,includingtheRadiationTherapyOncologyGroup(RTOG)andEuropeanOrganizationforResearchandTreatmentofCancer(EORTC).Onlystudiesrelatedtomedicineorphysics(includingradiationoncology,imaging,oncologyorcancer)wereincluded.Themethodologyusedinthesearticlesincludinghoweachconsensuswasreachedandstudyvaliditywasreviewed,andanysimilaritiesanddifferencesfoundinthecontouringguidelinesweredetailed.ResultsLiteratureSearchAtotalofsevenpublicationsrelatingtocontouringguidelinesforpostoperativeprostateradiotherapywereidentified[17-23