Topics:
Radiation Oncology • Gastrointestinal Cancers
When contouring pelvic lymph nodes in rectal and anal carcinoma, do you exclude bowel from your CTV?
The RTOG consensus guidelines suggest to not exclude small bowel when it falls into the space occupied by the rectal mesentery. Meanwhile, prostate and gyn atlases specifically mention to exclude small bowel from pelvic nodal CTV, while the RTOG anorectal atlas does not (just bone and pelvic sidewall). Do you routinely incorporate this into your practice? Elective Clinical Target Volumes for Conformal Therapy in Anorectal Cancer: An RTOG Consensus Panel Contouring Atlas (nih.gov)
Answer from: Radiation Oncologist at Academic Institution
Normally, there is no small bowel in spaces usually occupied by the mesorectal compartment. Occasionally, however, you can have a patient with a loop of small bowel in the pouch of Douglas. If imaging studies show small bowel where you would normally contour your CTV, the most important thing to do ...
Answer from: Radiation Oncologist at Community Practice
I tend to exclude from CTV contours, and just because I had followed the GYN atlas and did not change practice based on the anorectal guidelines. One would presume that the CTV was the same in both cases. It does make some sense that because bowel is mobile that it probably should be in the CTV. Wit...
The new NRG post op Gyn atlas published in the IJR...