Journal of Zhejiang University SCIENCE B

, Volume 10, Issue 9, pp 683–688 | Cite as

Evaluation of pelvic lymph node coverage of conventional radiotherapy fields based on bony landmarks in Chinese cervical cancer patients using CT simulation

Article

Abstract

Objective

To evaluate the pelvic lymph node coverage of conventional pelvic fields based on bony landmarks in Chinese patients with cervical cancer by using computed tomography (CT) simulation images to contour pelvic vessels as substitutes for lymph nodes location.

Methods

A retrospective review of CT simulation images and conventional pelvic radiation planning data sets was performed in 100 patients with cervical cancer at the International Federation of Gynecology and Obstetrics (FIGO) Stage IIB to IIIB in our hospital. Pelvic arteries were contoured on CT simulation images, and the outlines of conventional pelvic fields were drawn as defined by the gynecologic oncology group (GOG) after hiding the contours. The distances between the following vessel contours and field borders were measured: D 1, the superior border of the anterior/posterior (AP) field and the bifurcation of abdominal aorta; D 2, the ipsilateral border of the AP field and the distal end of external iliac artery; and D 3, the anterior border of the lateral (LAT) field and the distal end of the external iliac artery. The distances were recorded as positive values if the measuring point was within the conventional pelvic fields, or they were recorded as negative values. Lymph nodes coverage was considered adequate when D 1≥0 mm, D 2≥17 mm or D 3≥7 mm.

Results

All patients had at least 1 inadequate margin, 97 patients (97.0%) had 2, and 22 patients (22.0%) had all the 3. On the AP field, 95 patients (95%) had the measuring point, the bifurcation of the abdominal aorta, out of the field (D 1<0 mm), and all the patients had a distance less than 17.0 mm between the distal end of the external iliac artery and ipsilateral border (D 2<17.0 mm). On the LAT field, 24 patients (24%) had a distance less than 7.0 mm between the distal end of the external iliac artery and anterior border (D 3<7.0 mm).

Conclusion

We observed that conventional pelvic fields based on bony landmarks provided inadequate coverage of pelvic lymph nodes in our patients with cervical cancer. CT simulation may be a feasible technique for planning pelvic fields optimally and individually.

Key words

Cervical cancer Radiotherapy planning Computed tomography (CT) simulation Lymph nodes 

CLC number

R737 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Bonin, S.R., Lanciano, R.M., Corn, B.W., Hogan, W.M., Hartz, W.H., Hanks, G.E., 1996. Bony landmarks are not an adequate substitute for lymphangiography in defining pelvic lymph node location for the treatment of cervical cancer with radiotherapy. Int. J. Radiat. Oncol. Biol. Phys., 34(1):167–172.PubMedGoogle Scholar
  2. Eifel, P.J., Winter, K., Morris, M., Levenback, C., Grigsby, P.W., Cooper, J., Rotman, M., Gershenson, D., Mutch, D.G., 2004. Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer: an update of radiation therapy oncology group trial (RTOG) 90-01. J. Clin. Oncol., 22(5):872–880. [doi:10.1200/JCO.2004.07.197]PubMedCrossRefGoogle Scholar
  3. Finlay, M.H., Ackerman, I., Tirona, R.G., Hamilton, P., Barbera, L., Thomas, G., 2006. Use of CT simulation for treatment of cervical cancer to assess the adequacy of lymph node coverage of conventional pelvic fields based on bony landmarks. Int. J. Radiat. Oncol. Biol. Phys., 64(1):205–209.PubMedGoogle Scholar
  4. Greer, B.E., Koh, W.J., Figge, D.C., Russell, A.H., Cain, J.M., Tamimi, H.K., 1990. Gynecologic radiotherapy fields defined by intraoperative measurements. Gynecol. Oncol., 38(3):421–424. [doi:10.1016/0090-8258(90)90084-X]PubMedCrossRefGoogle Scholar
  5. Marnitz, S., Kohler, C., Schneider, A., Seiler, F., Hinkelbein, W., 2006. Interindividual variability of lymph drainages in patients with cervical cancer. Implication on irradiation planning. Strahlenther. Onkol., 182(2):80–85. [doi:10. 1007/s00066-006-1470-7]PubMedCrossRefGoogle Scholar
  6. McAlpine, J., Schlaerth, J.B., Lim, P., Chen, D., Eisenkop, S.M., Spirtos, N.M., 2004. Radiation fields in gynecologic oncology: correlation of soft tissue (surgical) to radiologic landmarks. Gynecol. Oncol., 92(1):25–30. [doi: 10.1016/j.ygyno.2003.09.008]PubMedCrossRefGoogle Scholar
  7. Parkin, D.M., Bray, F., Ferlay, J., Pisani, P., 2001. Estimating the world cancer burden: Globocan 2000. Int. J. Cancer, 94(2):153–156. [doi:10.1002/ijc.1440]PubMedCrossRefGoogle Scholar
  8. Pearcey, R., Brundage, M., Drouin, P., Jeffrey, J., Johnston, D., Lukka, H., MacLean, G., Souhami, L., Stuart, G., Tu, D., 2002. Phase III trial comparing radical radiotherapy with and without cisplatin chemotherapy in patients with advanced squamous cell cancer of the cervix. J. Clin. Oncol., 20(4):966–972. [doi:10.1200/JCO.20.4.966]PubMedCrossRefGoogle Scholar
  9. Pendlebury, S.C., Cahill, S., Crandon, A.J., Bull, C.A., 1993. Role of bipedal lymphangiogram in radiation treatment planning for cervix cancer. Int. J. Radiat Oncol. Biol. Phys., 27(4):959–962.PubMedGoogle Scholar
  10. Perez, C.A., Kuske, R.R., Camel, H.M., Galakatos, A.E., Hederman, M.A., Kao, M.S., Walz, B.J., 1988. Analysis of pelvic tumor control and impact on survival in carcinoma of the uterine cervix treated with radiation therapy alone. Int. J. Radiat. Oncol. Biol. Phys., 14(4):613–621.PubMedGoogle Scholar
  11. Taylor, A., Rockall, A.G., Reznek, R.H., Powell, M.E., 2005. Mapping pelvic lymph nodes: guidelines for delineation in intensity-modulated radiotherapy. Int. J. Radiat. Oncol. Biol. Phys., 63(5):1604–1612. [doi:10.1016/j.ijrobp.2005. 05.062]PubMedCrossRefGoogle Scholar
  12. Tewari, K.S., Monk, B.J., 2009. Recent achievements and future developments in advanced and recurrent cervical cancer: trials of the gynecologic oncology group. Semin. Oncol., 36(2):170–180. [doi:10.1053/j.seminoncol.2008. 12.008]PubMedCrossRefGoogle Scholar
  13. Thomas, L., Chacon, B., Kind, M., Lasbareilles, O., Muyldermans, P., Chemin, A., Le Treut, A., Pigneux, J., Kantor, G., 1997. Magnetic resonance imaging in the treatment planning of radiation therapy in carcinoma of the cervix treated with the four-field pelvic technique. Int. J. Radiat. Oncol. Biol. Phys., 37(4):827–832.PubMedGoogle Scholar
  14. Withers, H.R., Peters, L.J., Taylor, J.M., 1995. Dose-response relationship for radiation therapy of subclinical disease. Int. J. Radiat. Oncol. Biol. Phys., 31(2):353–359. [doi:10.1016/0360-3016(94)00354-N]PubMedGoogle Scholar
  15. Zunino, S., Rosato, O., Lucino, S., Jauregui, E., Rossi, L., Venencia, D., 1999. Anatomic study of the pelvis in carcinoma of the uterine cervix as related to the box technique. Int. J. Radiat. Oncol. Biol. Phys., 44(1):53–59. [doi:10.1016/S0360-3016(98)00538-0]PubMedCrossRefGoogle Scholar

Copyright information

© Zhejiang University and Springer Berlin Heidelberg 2009

Authors and Affiliations

  1. 1.Department of Gynecologic OncologyZhejiang Cancer HospitalHangzhouChina

Personalised recommendations