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. 2021 Jan 1;109(1):174-185.
doi: 10.1016/j.ijrobp.2020.08.034. Epub 2020 Aug 27.

NRG Oncology Updated International Consensus Atlas on Pelvic Lymph Node Volumes for Intact and Postoperative Prostate Cancer

William A Hall  1 , Eric Paulson  2 , Brian J Davis  3 , Daniel E Spratt  4 , Todd M Morgan  5 , David Dearnaley  6 , Alison C Tree  6 , Jason A Efstathiou  7 , Mukesh Harisinghani  8 , Ashesh B Jani  9 , Mark K Buyyounouski  10 , Thomas M Pisansky  3 , Phuoc T Tran  11 , R Jeffrey Karnes  12 , Ronald C Chen  13 , Fabio L Cury  14 , Jeff M Michalski  15 , Seth A Rosenthal  16 , Bridget F Koontz  17 , Anthony C Wong  18 , Paul L Nguyen  19 , Thomas A Hope  20 , Felix Feng  18 , Howard M Sandler  21 , Colleen A F Lawton  2
Affiliations

NRG Oncology Updated International Consensus Atlas on Pelvic Lymph Node Volumes for Intact and Postoperative Prostate Cancer

William A Hall et al. Int J Radiat Oncol Biol Phys. .

Abstract

Purpose: In 2009, the Radiation Therapy Oncology Group (RTOG) genitourinary members published a consensus atlas for contouring prostate pelvic nodal clinical target volumes (CTVs). Data have emerged further informing nodal recurrence patterns. The objective of this study is to provide an updated prostate pelvic nodal consensus atlas.

Methods and materials: A literature review was performed abstracting data on nodal recurrence patterns. Data were presented to a panel of international experts, including radiation oncologists, radiologists, and urologists. After data review, participants contoured nodal CTVs on 3 cases: postoperative, intact node positive, and intact node negative. Radiation oncologist contours were analyzed qualitatively using count maps, which provided a visual assessment of controversial regions, and quantitatively analyzed using Sorensen-Dice similarity coefficients and Hausdorff distances compared with the 2009 RTOG atlas. Diagnostic radiologists generated a reference table outlining considerations for determining clinical node positivity.

Results: Eighteen radiation oncologists' contours (54 CTVs) were included. Two urologists' volumes were examined in a separate analysis. The mean CTV for the postoperative case was 302 cm3, intact node positive case was 409 cm3, and intact node negative case was 342 cm3. Compared with the original RTOG consensus, the mean Sorensen-Dice similarity coefficient for the postoperative case was 0.63 (standard deviation [SD] 0.13), the intact node positive case was 0.68 (SD 0.13), and the intact node negative case was 0.66 (SD 0.18). The mean Hausdorff distance (in cm) for the postoperative case was 0.24 (SD 0.13), the intact node positive case was 0.23 (SD 0.09), and intact node negative case was 0.33 (SD 0.24). Four regions of CTV controversy were identified, and consensus for each of these areas was reached.

Conclusions: Discordance with the 2009 RTOG consensus atlas was seen in a group of experienced NRG Oncology and international genitourinary radiation oncologists. To address areas of variability and account for new data, an updated NRG Oncology consensus contour atlas was developed.

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Figures

Fig. 1.
Fig. 1.
Summary criteria for clinical node positivity. Abbreviations: CT = computed tomography; LN = lymph node; MRI = magnetic resonance imaging; PET = positron emission tomography; PSMA = prostate-specific membrane antigen.
Fig. 2.
Fig. 2.
Count maps showing controversial regions identified.
Fig. 3.
Fig. 3.
(A–M) New consensus contours on computed tomography. Abbreviation: CTV = clinical target volumes.
Fig. 3.
Fig. 3.
(A–M) New consensus contours on computed tomography. Abbreviation: CTV = clinical target volumes.
Fig. 4.
Fig. 4.
(A–G): New consensus contours on magnetic resonance.
See this image and copyright information in PMC

Comment in

  • In regard to Hall et al and Small et al.
    Musunuru HB, Keller A, Pifer P, Beriwal S. Musunuru HB, et al. Int J Radiat Oncol Biol Phys. 2021 Mar 15;109(4):1125-1126. doi: 10.1016/j.ijrobp.2020.11.043. Int J Radiat Oncol Biol Phys. 2021. PMID: 33610294 No abstract available.
  • In Regard to Hall et al.
    Onal C, Oymak E, Guler OC. Onal C, et al. Int J Radiat Oncol Biol Phys. 2021 Jun 1;110(2):619-620. doi: 10.1016/j.ijrobp.2021.01.040. Int J Radiat Oncol Biol Phys. 2021. PMID: 33989588 No abstract available.
  • In Reply to Onal et al.
    Hall WA, Lawton CAF; coauthors. Hall WA, et al. Int J Radiat Oncol Biol Phys. 2021 Jun 1;110(2):620-621. doi: 10.1016/j.ijrobp.2021.01.039. Int J Radiat Oncol Biol Phys. 2021. PMID: 33989589 No abstract available.

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