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International Journal of Radiation... Feb 2021Accurate target definition is critical for the appropriate application of radiation therapy. In 2008, the Radiation Therapy Oncology Group (RTOG) published an...
NRG Oncology/RTOG Consensus Guidelines for Delineation of Clinical Target Volume for Intensity Modulated Pelvic Radiation Therapy in Postoperative Treatment of Endometrial and Cervical Cancer: An Update.
PURPOSE
Accurate target definition is critical for the appropriate application of radiation therapy. In 2008, the Radiation Therapy Oncology Group (RTOG) published an international collaborative atlas to define the clinical target volume (CTV) for intensity modulated pelvic radiation therapy in the postoperative treatment of endometrial and cervical cancer. The current project is an updated consensus of CTV definitions, with removal of all references to bony landmarks and inclusion of the para-aortic and inferior obturator nodal regions.
METHODS AND MATERIALS
An international consensus guideline working group discussed modifications of the current atlas and areas of controversy. A document was prepared to assist in contouring definitions. A sample case abdominopelvic computed tomographic image was made available, on which experts contoured targets. Targets were analyzed for consistency of delineation using an expectation-maximization algorithm for simultaneous truth and performance level estimation with kappa statistics as a measure of agreement between observers.
RESULTS
Sixteen participants provided 13 sets of contours. Participants were asked to provide separate contours of the following areas: vaginal cuff, obturator, internal iliac, external iliac, presacral, common iliac, and para-aortic regions. There was substantial agreement for the common iliac region (sensitivity 0.71, specificity 0.981, kappa 0.64), moderate agreement in the external iliac, para-aortic, internal iliac and vaginal cuff regions (sensitivity 0.66, 0.74, 0.62, 0.59; specificity 0.989, 0.966, 0.986, 0.976; kappa 0.60, 0.58, 0.52, 0.47, respectively), and fair agreement in the presacral and obturator regions (sensitivity 0.55, 0.35; specificity 0.986, 0.988; kappa 0.36, 0.21, respectively). A 95% agreement contour was smoothed and a final contour atlas was produced according to consensus.
CONCLUSIONS
Agreement among the participants was most consistent in the common iliac region and least in the presacral and obturator nodal regions. The consensus volumes formed the basis of the updated NRG/RTOG Oncology postoperative atlas. Continued patterns of recurrence research are encouraged to refine these volumes.
Topics: Consensus; Documentation; Endometrial Neoplasms; Female; Humans; Internationality; Organs at Risk; Postoperative Period; Practice Guidelines as Topic; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Intensity-Modulated; Societies, Medical; Tomography, X-Ray Computed; Uterine Cervical Neoplasms
PubMed: 32905846
DOI: 10.1016/j.ijrobp.2020.08.061 -
International Journal of Radiation... Jun 2008To develop an atlas of the clinical target volume (CTV) definitions for postoperative radiotherapy of endometrial and cervical cancer to be used for planning pelvic...
PURPOSE
To develop an atlas of the clinical target volume (CTV) definitions for postoperative radiotherapy of endometrial and cervical cancer to be used for planning pelvic intensity-modulated radiotherapy.
METHODS AND MATERIALS
The Radiation Therapy Oncology Group led an international collaboration of cooperative groups in the development of the atlas. The groups included the Radiation Therapy Oncology Group, Gynecologic Oncology Group, National Cancer Institute of Canada, European Society of Therapeutic Radiology and Oncology, and American College of Radiology Imaging Network. The members of the group were asked by questionnaire to define the areas that were to be included in the CTV and to outline theses areas on individual computed tomography images. The initial formulation of the group began in late 2004 and culminated with a formal consensus conference in June 2005.
RESULTS
The committee achieved a consensus CTV definition for postoperative therapy for endometrial and cervical cancer. The CTV should include the common, external, and internal iliac lymph node regions. The upper 3.0 cm of the vagina and paravaginal soft tissue lateral to the vagina should also be included. For patients with cervical cancer, or endometrial cancer with cervical stromal invasion, it is also recommended that the CTV include the presacral lymph node region.
CONCLUSION
This report serves as an international template for the definition of the CTV for postoperative intensity-modulated radiotherapy for endometrial and cervical cancer.
Topics: Endometrial Neoplasms; Female; Humans; International Cooperation; Medical Illustration; Radiation Oncology; Radiotherapy Dosage; Radiotherapy, Intensity-Modulated; Tomography, X-Ray Computed; Tumor Burden; Uterine Cervical Neoplasms
PubMed: 18037584
DOI: 10.1016/j.ijrobp.2007.09.042 -
Cancer Diagnosis & Prognosis 2021It was recently shown that rare germline loss-of-function variants in the tyrosine-protein phosphatase non-receptor type 14 (PTPN14) gene conferred substantial risk of...
BACKGROUND/AIM
It was recently shown that rare germline loss-of-function variants in the tyrosine-protein phosphatase non-receptor type 14 (PTPN14) gene conferred substantial risk of basal cell carcinoma (BCC). A follow-up investigation of 24 cancers and three benign tumor types showed that PTPN14 loss-of-function variants were associated with high risk of cervical cancer and early age at diagnosis. We used the Cancer Genome Atlas (TCGA) to further evaluate the PTPN14 - cervical cancer association.
MATERIALS AND METHODS
We analyzed the Genomic Data Commons (GDC) TCGA Cervical Cancer (CESC) data set. We used cBioPortal for Cancer Genomics to access data in TCGA. cBioPortal provides visualization, analysis and download options for large-scale cancer genomic data sets. We also accessed TCGA data with the University of California Santa Cruz (UCSC) Xena Browser. UCSC Xena allows users to explore functional genomic data sets for assessing correlations between genomic and/or phenotypic variables.
RESULTS
Ten patients with PTPN14 mutations had significantly better survival than 266 patients without PTPN14 mutations (p=0.05 log rank test). In the Human Protein Atlas, low expression of PTPN14 in 85 TCGA cervical cancer specimens was associated with better survival than high expression in 206 cervical cancer specimens.
CONCLUSION
In general, factors that affect the risk of a cancer have the same effect on prognosis. For example, history of allergy reduces risk of malignant brain tumors and improves prognosis. However, this relationship is not the case for PTPN14. We conclude that in TCGA cervical cancer specimens, PTPN14 mutation is a favorable prognostic factor. However, germline variants of PTPN14 confer a worse prognosis. Further studies of the specific mutations would be worthwhile.
PubMed: 35403138
DOI: 10.21873/cdp.10035 -
Journal of Radiology Case Reports Aug 2013Craniocervical bony pneumatization is a rare finding, with limited numbers of cases reported in the literature. It is thought to be linked to Eustachian tube dysfunction...
Craniocervical bony pneumatization is a rare finding, with limited numbers of cases reported in the literature. It is thought to be linked to Eustachian tube dysfunction and a ball valve mechanism, and has a link with recurrent Valsalva maneuvers. We report a case of pneumatization of the occiput, atlas (C1) and axis (C2) in a patient with extensive ENT (Ear, Nose and Throat) surgical history who presented following a fall. Plain film, CT and MRI images are presented.
Topics: Cervical Atlas; Emphysema; Humans; Incidental Findings; Male; Middle Aged; Occipital Bone; Rare Diseases; Spinal Diseases; Tomography, X-Ray Computed
PubMed: 24421950
DOI: 10.3941/jrcr.v7i8.1444 -
Proceedings of the Royal Society of... Sep 1961
Topics: Axis, Cervical Vertebra; Cervical Atlas; Child; Fractures, Bone; Humans; Infant; Joint Dislocations
PubMed: 14476765
DOI: No ID Found