• Radiother Oncol · Mar 2005

    Review

    Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (I): concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV.

    • Christine Haie-Meder, Richard Pötter, Erik Van Limbergen, Edith Briot, Marisol De Brabandere, Johannes Dimopoulos, Isabelle Dumas, Taran Paulsen Hellebust, Christian Kirisits, Stefan Lang, Sabine Muschitz, Juliana Nevinson, An Nulens, Peter Petrow, Natascha Wachter-Gerstner, and Gynaecological (GYN) GEC-ESTRO Working Group.
    • Department of Radiotherapy, Brachytherapy Unit, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France.
    • Radiother Oncol. 2005 Mar 1; 74 (3): 235-45.

    Background And PurposeBrachytherapy (BT) plays a crucial role in the management of invasive cervix cancer from stage I to IV. Intracavitary techniques are based on afterloading devices, with different types of applicators. CT and/or MRI compatible applicators allow a sectional image based approach with a better assessment of gross tumour volume (GTV) and definition and delineation of target volume (CTV) compared to traditional approaches. Accurate and reproducible delineation of GTV, CTV and PTV, as well as of critical organs has a direct impact on BT treatment planning, especially if it is possible to adapt the pear-shape isodose by optimisation using DVH analysis. When introducing a 3D image based approach for GTV and CTV assessment, there is a need for a common language to describe the concepts and to define the terms which are to be used.MethodsIn 2000, GEC-ESTRO decided to support 3D imaging based 3D treatment planning approach in cervix cancer BT with the creation of a Working Group. The task was to describe basic concepts and terms and to work out a terminology enabling various groups working in this advanced field to use a common language. The recommendations described in this report were proposed based on clinical experience and dosimetric concepts of different institutions (IGR, Leuven, Vienna) and were stepwise validated against the background of different clinical experience.ConclusionsAs GTV and CTV for BT change significantly during treatment, time frame for assessment of GTV and CTV for BT is specified in this report: at time of diagnosis GTV(D), CTV(D) and at time of BT GTV(B), CTV(B). Furthermore, CTV for BT is defined related to risk for recurrence: high risk CTV and intermediate risk CTV. Beside verbal descriptions detailed examples are given, partly in form of schematic drawings.

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