Validation and applicability of para-aortic lymph nodal contouring atlas in cervical cancer

  • Shashank Srinivasan
    Affiliations
    Department of Radiation Oncology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute, Mumbai, India
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  • Lavanya Gurram
    Correspondence
    Corresponding author at: Department of Radiation Oncology, Tata Memorial Hospital, Dr. E. Borges Road, Parel East, Mumbai 400012, India.
    Affiliations
    Department of Radiation Oncology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute, Mumbai, India
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  • Carlton Johnny
    Affiliations
    Department of Radiation Oncology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute, Mumbai, India
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  • Supriya Chopra
    Affiliations
    Department of Radiation Oncology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute, Mumbai, India
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  • A. Dheera
    Affiliations
    Department of Medical Physics, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute, Mumbai, India
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  • Akshay Baheti
    Affiliations
    Department of Radiodiagnosis, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute, Mumbai, India
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  • Palak Popat
    Affiliations
    Department of Radiodiagnosis, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute, Mumbai, India
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  • Nilesh Sable
    Affiliations
    Department of Radiodiagnosis, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute, Mumbai, India
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  • Venkatesh Rangarajan
    Affiliations
    Department of Nuclear Medicine, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute, Mumbai, India
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  • Umesh Mahantshetty
    Affiliations
    Department of Radiation Oncology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute, Mumbai, India

    Department of Radiation Oncology, Homi Bhabha Cancer Hospital and Research Centre, Vishakhapatnam, India
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Published:October 25, 2021DOI:https://doi.org/10.1016/j.radonc.2021.10.014

      Highlights

      • Validation of para-aortic nodal contouring guidelines in cervical cancer.
      • PALN most commonly located in LPA region below the inferior mesenteric artery.
      • More than 95% PALN covered using the proposed guidelines with the addition of an extra 5 mm margin laterally on the left.
      • Right para-caval region may be excluded above the level of the renal hilum.

      Abstract

      Background and purpose

      CTV delineation guidelines for the para-aortic nodal region for patients with cervical cancer have been proposed (Keenan et al., 2018). The purpose of this study was to validate these guidelines with the use of CT datasets of cervical cancer patients with macroscopic PALN treated with definitive (chemo)radiation (CTRT) at our center.

      Materials and methods

      Planning CT datasets of 71 cervical cancer patients with gross PA nodal disease treated with EFRT were used. Two hundred and two PALN were identified based on size and morphology on diagnostic CECT, PET CT, or histologically proven PALN. LN regions were divided into upper, middle, and lower and based on their relation to the aorta and IVC. Macroscopic PALN were contoured, and the CTV for PALN irradiation was generated based on the proposed guidelines on ECLIPSE (Version 13.5). The centre of mass (COMN) was calculated for each gross PALN. The evaluation was done to review the presence of COMN in relation to the CTV PALN.

      Results

      The most common location of PALN was Left para-aortic (105 LN-52%), Aortocaval (55 LN-27.2%), and Precaval (14 LN-6.9%). Lower PALN were the commonest (104 LN-51.5%). Ninety-three were middle PALN (46%), and 5 were upper PALN (2.5%). After excluding upper PALN, COMN for 11 PALN (5.5%) were outside the CTV while 20 were junctional.

      Conclusion

      Our study shows that more than 95% of PALN in this patient cohort were covered using these guidelines with the addition of an extra 5 mm margin laterally on the left.

      Keywords

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