Development and Validation of Consensus Contouring Guidelines for Adjuvant Radiation Therapy for Bladder Cancer After Radical Cystectomy

Journal Article · Thu Sep 01 04:00:00 EDT 2016 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2016.04.032· OSTI ID:22648783

Baumann, Brian C. ^[1]; Bosch, Walter R. ^[2]; Bahl, Amit ^[3]; Birtle, Alison J. ^[4]; Breau, Rodney H. ^[5]; Challapalli, Amarnath ^[3]; Chang, Albert J. ^[6]; Choudhury, Ananya ^[7]; Daneshmand, Sia ^[8]; El-Gayed, Ali ^[9]; Feldman, Adam ^[10]; Finkelstein, Steven E. ^[11]; Guzzo, Thomas J. ^[1]; Hilman, Serena ^[3]; Jani, Ashesh ^[12]; Malkowicz, S. Bruce ^[1]; Mantz, Constantine A. ^[13]; Master, Viraj ^[12]; Mitra, Anita V. ^[14]; Murthy, Vedang ^[15] ; others, and

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1. Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania (United States)
2. Washington University in St. Louis, St. Louis, Missouri (United States)
3. University Hospitals Bristol NHS Foundation Trust, Bristol (United Kingdom)
4. Royal Preston Hospital, Preston (United Kingdom)
5. University of Ottawa, Ottawa, Ontario (Canada)
6. University of California San Francisco, San Francisco, California (United States)
7. Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester (United Kingdom)
8. University of Southern California, Los Angeles, California (United States)
9. Saskatoon Cancer Centre, Saskatoon (Canada)
10. Massachusetts General Hospital, Boston, Massachusetts (United States)
11. Cancer Treatment Centers of America, Tulsa, Oklahoma (United States)
12. Emory University, Atlanta, Georgia (United States)
13. 21st Century Oncology, Scottsdale, Arizona (United States)
14. University College London Hospital, London (United Kingdom)
15. Tata Memorial Center, Mumbai (India)

Purpose: To develop multi-institutional consensus clinical target volumes (CTVs) and organs at risk (OARs) for male and female bladder cancer patients undergoing adjuvant radiation therapy (RT) in clinical trials. Methods and Materials: We convened a multidisciplinary group of bladder cancer specialists from 15 centers and 5 countries. Six radiation oncologists and 7 urologists participated in the development of the initial contours. The group proposed initial language for the CTVs and OARs, and each radiation oncologist contoured them on computed tomography scans of a male and female cystectomy patient with input from ≥1 urologist. On the basis of the initial contouring, the group updated its CTV and OAR descriptions. The cystectomy bed, the area of greatest controversy, was contoured by another 6 radiation oncologists, and the cystectomy bed contouring language was again updated. To determine whether the revised language produced consistent contours, CTVs and OARs were redrawn by 6 additional radiation oncologists. We evaluated their contours for level of agreement using the Landis-Koch interpretation of the κ statistic. Results: The group proposed that patients at elevated risk for local-regional failure with negative margins should be treated to the pelvic nodes alone (internal/external iliac, distal common iliac, obturator, and presacral), whereas patients with positive margins should be treated to the pelvic nodes and cystectomy bed. Proposed OARs included the rectum, bowel space, bone marrow, and urinary diversion. Consensus language describing the CTVs and OARs was developed and externally validated. The revised instructions were found to produce consistent contours. Conclusions: Consensus descriptions of CTVs and OARs were successfully developed and can be used in clinical trials of adjuvant radiation therapy for bladder cancer.

• OSTI ID: 22648783
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 1 Vol. 96; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BLADDER
BONE MARROW
CLINICAL TRIALS
COMPUTERIZED TOMOGRAPHY
MEDICAL PERSONNEL
NEOPLASMS
PATIENTS
RADIATION HAZARDS
RADIOTHERAPY