rtog sarcoma working group consensus on the gtv. · pdf file1 rtog sarcoma working group...
TRANSCRIPT
![Page 1: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/1.jpg)
1
RTOG Sarcoma Working Group
Consensus on The GTV and CTV
Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein, Ivy Petersen, Michael Haddock, Yen-Lin E.
Chen, Naoyuki G. Saito, David G. Kirsch, Ying J. Hitchcock, Aaron H. Wolfson, Thomas F. DeLaney, Dian Wang.
![Page 2: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/2.jpg)
RTOG Extremity Soft
Tissue Sarcoma Atlas
RTOG Sarcoma Working Group Consensus
on The GTV and CTV For Preoperative
Radiotherapy of Large High Grade
Extremity Soft Tissue Sarcoma
2
![Page 3: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/3.jpg)
Definition of GTV and CTV • Gross Target Volume (GTV): Gross tumor defined by MRI T1 plus
contrast images (MRI with contrast is required). Fusion of MRI and CT is recommended to delineate the GTV for radiotherapy planning. Intravenous contrast is recommended, particularly for upper extremity lesions, where there is a greater rotational mobility and positioning fidelity between the diagnostic MRI and the planning CT may be more difficult to achieve
• Clinical Target Volume (CTV) for intermediate-to-high grade sarcoma ≥ 5 cm: Include gross tumor and clinical microscopic margins. Typically CTV = GTV plus 3 cm margins in the longitudinal (proximal and distal) directions. If this causes the field to extend beyond the compartment, the field can be shortened to include the end of a compartment. The radial margin from the lesion should be 1.5 cm including any portion of the tumor not confined by an intact fascial barrier, bone or skin surface. The suspicious edema defined on MRI T2 images is often included within the above margins. However, clinical judgment is required to make sure if the above margins need to be extended to cover the T2 edema defined on MRI T2 images. For example, the extensive T2 edema may be excluded if clinical judgment suggests that the risk of the edema harboring sarcoma many cm beyond the GTV is low or if extending the radiation field to include all of the edema would cause excessive toxicity.
3
![Page 4: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/4.jpg)
Example Case
• 55-year-old male with a large high-grade round cell liposarcoma in right distal thigh. Clinical stage (AJCC 7th edition) III T2bN0M0G3.
– The MRI of right distal thigh showed a large well circumscribed heterogeneous, multiloculated mass located within the posterior thigh.
– The tumor measured 14.8 cm in craniocaudal dimension, 7.8 cm in AP dimension, and 11.3 cm in maximal medial-lateral dimension.
• Simulation CT images were fused with those from the diagnostic thigh MRI
4
![Page 5: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/5.jpg)
Consensus Contours
• The consensus contours for the GTV and CTV were generated based on the modification of the 95% agreement contours by RTOG Sarcoma Working Group Radiation Oncologists
– RTOG Sarcoma Radiation Oncologists Reach Consensus on Gross Tumor Volume (GTV) and Clinical Target Volume (CTV) on Computed Tomographic Images for Preoperative Radiotherapy of Primary Soft Tissue Sarcoma of Extremity in RTOG Studies. IJROBP June 2011
5
![Page 6: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/6.jpg)
6
![Page 7: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/7.jpg)
7
←CTV
![Page 8: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/8.jpg)
8
←CTV
![Page 9: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/9.jpg)
9
←CTV
![Page 10: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/10.jpg)
10
←CTV
![Page 11: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/11.jpg)
11
←CTV
![Page 12: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/12.jpg)
12
←CTV
![Page 13: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/13.jpg)
13
←CTV
![Page 14: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/14.jpg)
14
←CTV
![Page 15: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/15.jpg)
15
←CTV
![Page 16: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/16.jpg)
16
←CTV
![Page 17: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/17.jpg)
17
←CTV
![Page 18: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/18.jpg)
18
←CTV
![Page 19: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/19.jpg)
19
GTV→ ←CTV
![Page 20: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/20.jpg)
20
GTV→ ←CTV
![Page 21: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/21.jpg)
21
GTV→ ←CTV
![Page 22: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/22.jpg)
22
GTV→ ←CTV
![Page 23: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/23.jpg)
23
GTV→ ←CTV
![Page 24: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/24.jpg)
24
GTV→ ←CTV
![Page 25: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/25.jpg)
25
GTV→ ←CTV
![Page 26: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/26.jpg)
26
GTV→ ←CTV
![Page 27: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/27.jpg)
27
GTV→ ←CTV
![Page 28: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/28.jpg)
28
GTV→ ←CTV
![Page 29: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/29.jpg)
29
GTV→ ←CTV
![Page 30: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/30.jpg)
30
GTV→ ←CTV
![Page 31: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/31.jpg)
31
GTV→ ←CTV
![Page 32: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/32.jpg)
32
GTV→ ←CTV
![Page 33: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/33.jpg)
33
GTV→ ←CTV
![Page 34: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/34.jpg)
34
GTV→ ←CTV
![Page 35: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/35.jpg)
35
GTV→ ←CTV
![Page 36: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/36.jpg)
36
GTV→ ←CTV
![Page 37: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/37.jpg)
37
GTV→ ←CTV
![Page 38: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/38.jpg)
38
GTV→ ←CTV
![Page 39: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/39.jpg)
39
GTV→ ←CTV
![Page 40: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/40.jpg)
40
GTV→ ←CTV
![Page 41: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/41.jpg)
41
GTV→ ←CTV
![Page 42: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/42.jpg)
42
GTV→ ←CTV
![Page 43: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/43.jpg)
43
GTV→ ←CTV
![Page 44: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/44.jpg)
44
GTV→ ←CTV
![Page 45: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/45.jpg)
45
GTV→ ←CTV
![Page 46: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/46.jpg)
46
GTV→ ←CTV
![Page 47: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/47.jpg)
47
GTV→ ←CTV
![Page 48: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/48.jpg)
48
←CTV
GTV→
![Page 49: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/49.jpg)
49
←CTV
GTV→
![Page 50: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/50.jpg)
50
←CTV
GTV→
![Page 51: RTOG Sarcoma Working Group Consensus on The GTV. · PDF file1 RTOG Sarcoma Working Group Consensus on The GTV and CTV Dian Wang, Walter Bosch, David Roberge, Steven E. Finkelstein,](https://reader034.vdocuments.mx/reader034/viewer/2022051305/5a9d8bd67f8b9a21688c2af2/html5/thumbnails/51.jpg)
51