An atlas for clinical target volume definition, including elective nodal irradiation in definitive radiotherapy of biliary cancer

Bisello,Silvia; Renzulli,Matteo; Buwenge,Milly; Calculli,Lucia; Sallustio,Giuseppina; Macchia,Gabriella; Deodato,Francesco; Mattiucci,Giancarlo; Cammelli,Silvia; Arcelli,Alessandra; Giaccherini,Lucia; Cellini,Francesco; Brandi,Giovanni; Guerri,Sara; Cilla,Savino; Golfieri,Rita; Fuccio,Lorenzo; Morganti,Alessio  G.; Guido,Alessandra

doi:10.3892/ol.2018.9774

An atlas for clinical target volume definition, including elective nodal irradiation in definitive radiotherapy of biliary cancer

Authors:
- Silvia Bisello
- Matteo Renzulli
- Milly Buwenge
- Lucia Calculli
- Giuseppina Sallustio
- Gabriella Macchia
- Francesco Deodato
- Giancarlo Mattiucci
- Silvia Cammelli
- Alessandra Arcelli
- Lucia Giaccherini
- Francesco Cellini
- Giovanni Brandi
- Sara Guerri
- Savino Cilla
- Rita Golfieri
- Lorenzo Fuccio
- Alessio G. Morganti
- Alessandra Guido
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Affiliations: Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola‑Malpighi Hospital, I‑40138 Bologna, Italy, Radiology Unit, Department of Diagnostic and Preventive Medicine, S. Orsola‑Malpighi Hospital, I‑40138 Bologna, Italy, Radiology Unit, Catholic University of The Sacred Heart, I‑86100 Campobasso, Italy, Radiation Oncology Unit, Catholic University of The Sacred Heart, I‑86100 Campobasso, Italy, Radiation Oncology Department, Sacred Heart Catholic University, I‑00168 Rome, Italy, Department of Experimental, Diagnostic and Specialty Medicine, ‘L. e. A. Seragnoli’ Institute of Hematology and Medical Oncology, S. Orsola‑Malpighi Hospital, I‑40138 Bologna, Italy, Medical Physics Unit ‘Giovanni Paolo II’ Foundation, Catholic University of the Sacred Heart, I‑86100 Campobasso, Italy, Department of Medical and Surgical Sciences, University of Bologna, I‑40138 Bologna, Italy
Published online on: November 28, 2018 https://doi.org/10.3892/ol.2018.9774
Pages: 1784-1790
Copyright: © Bisello et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Radiotherapy (RT) is a treatment option for advanced biliary tract cancer (BTC), often combined with sequential and/or concurrent chemotherapy. The use of modern RT techniques requires accurate clinical target volume (CTV) definition and delineation. However, guidelines for CTV delineation in BTC are lacking. Therefore, the aim of this study was to propose a computer tomography (CT) atlas for CTV definition of BTC. We previously proposed guidelines to define the nodal CTV (CTV‑N) in BTC. In this study, based on a literature analysis, we defined the margins to be added to the gross tumor volume (GTV; subclinical and microscopic disease) to define the primary tumor CTV (CTV‑T). An abdominal contrast enhanced planning CT scan was performed on three different patients with unresectable intrahepatic cholangiocarcinoma (CC), extrahepatic CC and gallbladder cancer. The GTV and anatomical reference structures were outlined on CT images. Then, based on our guidelines, the CTV‑T and CTV‑N were delineated and merged to define the final CTV in the three patients. An atlas, showing the defined CTV, was generated from the reference CT images to illustrate the CTV for intra‑hepatic CC, extra‑hepatic CC and gallbladder cancer. This atlas can be used as an aid for CTV definition in patients with BTC treated with modern RT techniques.

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