Recommendations for MRI-based contouring of gross tumor volume and organs at risk for radiation therapy of pancreatic cancer

H. D. Heerkens; W. A. Hall; X. A. Li; P. Knechtges; E. Dalah; E. S. Paulson; C. A.T. van den Berg; G. J. Meijer; E. J. Koay; C. H. Crane; K. Aitken; M. van Vulpen; B. A. Erickson

doi:10.1016/j.prro.2016.10.006

Recommendations for MRI-based contouring of gross tumor volume and organs at risk for radiation therapy of pancreatic cancer

H. D. Heerkens, W. A. Hall, X. A. Li, P. Knechtges, E. Dalah, E. S. Paulson, C. A.T. van den Berg, G. J. Meijer, E. J. Koay, C. H. Crane, K. Aitken, M. van Vulpen, B. A. Erickson

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Abstract

Purpose Local recurrence is a common and morbid event in patients with unresectable pancreatic adenocarcinoma. A more conformal and targeted radiation dose to the macroscopic tumor in nonmetastatic pancreatic cancer is likely to reduce acute toxicity and improve local control. Optimal soft tissue contrast is required to facilitate delineation of a target and creation of a planning target volume with margin reduction and motion management. Magnetic resonance imaging (MRI) offers considerable advantages in optimizing soft tissue delineation and is an ideal modality for imaging and delineating a gross tumor volume (GTV) within the pancreas, particularly as it relates to conformal radiation planning. Currently, no guidelines have been defined for the delineation of pancreatic tumors for radiation therapy treatment planning. Moreover, abdominal MRI sequences are complex and the anatomy relevant to the radiation oncologist can be challenging. The purpose of this study is to provide recommendations for delineation of GTV and organs at risk (OARs) using MRI and incorporating multiple MRI sequences. Methods and materials Five patients with pancreatic cancer and 1 healthy subject were imaged with MRI scans either on 1.5 T or on 3 T magnets in 2 separate institutes. The GTV and OARs were contoured for all patients in a consensus meeting. Results An overview of MRI-based anatomy of the GTV and OARs is provided. Practical contouring instructions for the GTV and the OARs with the aid of MRI were developed and included in these recommendations. In addition, practical suggestions for implementation of MRI in pancreatic radiation treatment planning are provided. Conclusions With this report, we attempt to provide recommendations for MRI-based contouring of pancreatic tumors and OARs. This could lead to better uniformity in defining the GTV and OARs for clinical trials and in radiation therapy treatment planning, with the ultimate goal of improving local control while minimizing morbidity.

Original language	English (US)
Pages (from-to)	126-136
Number of pages	11
Journal	Practical radiation oncology
Volume	7
Issue number	2
DOIs	https://doi.org/10.1016/j.prro.2016.10.006
State	Published - Mar 1 2017

ASJC Scopus subject areas

Oncology
Radiology Nuclear Medicine and imaging

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10.1016/j.prro.2016.10.006

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Heerkens, H. D., Hall, W. A., Li, X. A., Knechtges, P., Dalah, E., Paulson, E. S., van den Berg, C. A. T., Meijer, G. J., Koay, E. J., Crane, C. H., Aitken, K., van Vulpen, M., & Erickson, B. A. (2017). Recommendations for MRI-based contouring of gross tumor volume and organs at risk for radiation therapy of pancreatic cancer. Practical radiation oncology, 7(2), 126-136. https://doi.org/10.1016/j.prro.2016.10.006

Heerkens, HD, Hall, WA, Li, XA, Knechtges, P, Dalah, E, Paulson, ES, van den Berg, CAT, Meijer, GJ, Koay, EJ, Crane, CH, Aitken, K, van Vulpen, M & Erickson, BA 2017, 'Recommendations for MRI-based contouring of gross tumor volume and organs at risk for radiation therapy of pancreatic cancer', Practical radiation oncology, vol. 7, no. 2, pp. 126-136. https://doi.org/10.1016/j.prro.2016.10.006

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title = "Recommendations for MRI-based contouring of gross tumor volume and organs at risk for radiation therapy of pancreatic cancer",

abstract = "Purpose Local recurrence is a common and morbid event in patients with unresectable pancreatic adenocarcinoma. A more conformal and targeted radiation dose to the macroscopic tumor in nonmetastatic pancreatic cancer is likely to reduce acute toxicity and improve local control. Optimal soft tissue contrast is required to facilitate delineation of a target and creation of a planning target volume with margin reduction and motion management. Magnetic resonance imaging (MRI) offers considerable advantages in optimizing soft tissue delineation and is an ideal modality for imaging and delineating a gross tumor volume (GTV) within the pancreas, particularly as it relates to conformal radiation planning. Currently, no guidelines have been defined for the delineation of pancreatic tumors for radiation therapy treatment planning. Moreover, abdominal MRI sequences are complex and the anatomy relevant to the radiation oncologist can be challenging. The purpose of this study is to provide recommendations for delineation of GTV and organs at risk (OARs) using MRI and incorporating multiple MRI sequences. Methods and materials Five patients with pancreatic cancer and 1 healthy subject were imaged with MRI scans either on 1.5 T or on 3 T magnets in 2 separate institutes. The GTV and OARs were contoured for all patients in a consensus meeting. Results An overview of MRI-based anatomy of the GTV and OARs is provided. Practical contouring instructions for the GTV and the OARs with the aid of MRI were developed and included in these recommendations. In addition, practical suggestions for implementation of MRI in pancreatic radiation treatment planning are provided. Conclusions With this report, we attempt to provide recommendations for MRI-based contouring of pancreatic tumors and OARs. This could lead to better uniformity in defining the GTV and OARs for clinical trials and in radiation therapy treatment planning, with the ultimate goal of improving local control while minimizing morbidity.",

author = "Heerkens, {H. D.} and Hall, {W. A.} and Li, {X. A.} and P. Knechtges and E. Dalah and Paulson, {E. S.} and {van den Berg}, {C. A.T.} and Meijer, {G. J.} and Koay, {E. J.} and Crane, {C. H.} and K. Aitken and {van Vulpen}, M. and Erickson, {B. A.}",

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T1 - Recommendations for MRI-based contouring of gross tumor volume and organs at risk for radiation therapy of pancreatic cancer

AU - Heerkens, H. D.

AU - Hall, W. A.

AU - Li, X. A.

AU - Knechtges, P.

AU - Dalah, E.

AU - Paulson, E. S.

AU - van den Berg, C. A.T.

AU - Meijer, G. J.

AU - Koay, E. J.

AU - Crane, C. H.

AU - Aitken, K.

AU - van Vulpen, M.

AU - Erickson, B. A.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Purpose Local recurrence is a common and morbid event in patients with unresectable pancreatic adenocarcinoma. A more conformal and targeted radiation dose to the macroscopic tumor in nonmetastatic pancreatic cancer is likely to reduce acute toxicity and improve local control. Optimal soft tissue contrast is required to facilitate delineation of a target and creation of a planning target volume with margin reduction and motion management. Magnetic resonance imaging (MRI) offers considerable advantages in optimizing soft tissue delineation and is an ideal modality for imaging and delineating a gross tumor volume (GTV) within the pancreas, particularly as it relates to conformal radiation planning. Currently, no guidelines have been defined for the delineation of pancreatic tumors for radiation therapy treatment planning. Moreover, abdominal MRI sequences are complex and the anatomy relevant to the radiation oncologist can be challenging. The purpose of this study is to provide recommendations for delineation of GTV and organs at risk (OARs) using MRI and incorporating multiple MRI sequences. Methods and materials Five patients with pancreatic cancer and 1 healthy subject were imaged with MRI scans either on 1.5 T or on 3 T magnets in 2 separate institutes. The GTV and OARs were contoured for all patients in a consensus meeting. Results An overview of MRI-based anatomy of the GTV and OARs is provided. Practical contouring instructions for the GTV and the OARs with the aid of MRI were developed and included in these recommendations. In addition, practical suggestions for implementation of MRI in pancreatic radiation treatment planning are provided. Conclusions With this report, we attempt to provide recommendations for MRI-based contouring of pancreatic tumors and OARs. This could lead to better uniformity in defining the GTV and OARs for clinical trials and in radiation therapy treatment planning, with the ultimate goal of improving local control while minimizing morbidity.

AB - Purpose Local recurrence is a common and morbid event in patients with unresectable pancreatic adenocarcinoma. A more conformal and targeted radiation dose to the macroscopic tumor in nonmetastatic pancreatic cancer is likely to reduce acute toxicity and improve local control. Optimal soft tissue contrast is required to facilitate delineation of a target and creation of a planning target volume with margin reduction and motion management. Magnetic resonance imaging (MRI) offers considerable advantages in optimizing soft tissue delineation and is an ideal modality for imaging and delineating a gross tumor volume (GTV) within the pancreas, particularly as it relates to conformal radiation planning. Currently, no guidelines have been defined for the delineation of pancreatic tumors for radiation therapy treatment planning. Moreover, abdominal MRI sequences are complex and the anatomy relevant to the radiation oncologist can be challenging. The purpose of this study is to provide recommendations for delineation of GTV and organs at risk (OARs) using MRI and incorporating multiple MRI sequences. Methods and materials Five patients with pancreatic cancer and 1 healthy subject were imaged with MRI scans either on 1.5 T or on 3 T magnets in 2 separate institutes. The GTV and OARs were contoured for all patients in a consensus meeting. Results An overview of MRI-based anatomy of the GTV and OARs is provided. Practical contouring instructions for the GTV and the OARs with the aid of MRI were developed and included in these recommendations. In addition, practical suggestions for implementation of MRI in pancreatic radiation treatment planning are provided. Conclusions With this report, we attempt to provide recommendations for MRI-based contouring of pancreatic tumors and OARs. This could lead to better uniformity in defining the GTV and OARs for clinical trials and in radiation therapy treatment planning, with the ultimate goal of improving local control while minimizing morbidity.

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Recommendations for MRI-based contouring of gross tumor volume and organs at risk for radiation therapy of pancreatic cancer

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