How iliopelvic lymphoscintigraphy can affect the definition of planning target volume in radiation therapy of pelvic and testicular tumors

Franco Campostrini, Michele Gregianin, Lucia Rampin, Federico Lonardi, Alessandro De Lucchi, Manuela Coeli, Gloria Gioga, Morena Prina, Guido Ferretti, Michele Povolato

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: External beam radiation therapy (EBRT) of most intrapelvic and testicular tumors has been generally performed with large fields encompassing both the primary disease and lymphatic drainage. This study was carried out to map the pelvic and periaortic lymphatics by means of iliopelvic lymphoscintigraphy (IPL) in preparation for radiotherapy planning. Methods and Materials: Between January 2000 and October 2001, 70 patients scheduled for EBRT (61 operated on, 52 females, 18 males, mean age 61, range, 24-80), affected with uterine (43), rectal (11), testicular (8), anal (4), penile (2), and vulvar (2) cancers were enrolled in the study. IPL was performed by injection of 99mtechnetium-nanocolloids in the bipedal (70 cases) or bipedal plus perianal (20 cases) sites. The sensitivity of IPL in mapping the lymphatic anatomy was evaluated first. Then three radiation oncologists scored the modifications induced by IPL on the planning target volume (PTV) which had been previously delineated only on the basis of bony landmarks. The original fields were classified "inadequate" if they failed to match the new PTV by more than 1 cm. Results: IPL sensitivity in showing the inguinal, external iliac, common, and periaortic lymphatics was 100%, 90%, 80%, and 70% in anterior-posterior (A-P) projections, and 100%, 80%, 70%, and 60% in lateral projections respectively. For the presacral and hypogastric ones the sensitivity was 40%. When compared with bony landmarks, IPL changed the delineation of PTV in 24 of 70 A-P P-A fields (34%) and 22 of 58 (38%) lateral fields. Furthermore, 8/12 (67%) lymphadenectomies resulted in being incomplete. No IPL-related toxicity was observed. Conclusion: IPL is a safe, inexpensive (cost: 100 Euros), and effective method to map the lymphatic chains. In the A-P scintigrams these structures were detected in 85% (70-100%) of the patients referred for total pelvis irradiation, and this figure could be higher in subjects not operated on. IPL can also give a reliable evaluation of the lymphadenectomies in order to schedule the proper treatments after surgery. Finally, IPL may change the conventional PTV for pelvic irradiation in about 36% (34-38%) of the cases; therefore, the fields should be tailored more around the lymphatic landmarks than the bony landmarks.

Original languageEnglish
Pages (from-to)1303-1313
Number of pages11
JournalInternational Journal of Radiation Oncology Biology Physics
Volume53
Issue number5
DOIs
Publication statusPublished - Aug 1 2002

Fingerprint

Lymphoscintigraphy
Testicular Neoplasms
landmarks
planning
radiation therapy
Radiotherapy
tumors
sensitivity
projection
pelvis
irradiation
delineation
anatomy
schedules
drainage
Lymph Node Excision
surgery
toxicity
cancer
Vulvar Neoplasms

Keywords

  • Lymphoscintigraphy
  • Mapping the lymph nodes
  • Pelvic radiotherapy
  • Pelvic tumors
  • Target volumes

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

How iliopelvic lymphoscintigraphy can affect the definition of planning target volume in radiation therapy of pelvic and testicular tumors. / Campostrini, Franco; Gregianin, Michele; Rampin, Lucia; Lonardi, Federico; De Lucchi, Alessandro; Coeli, Manuela; Gioga, Gloria; Prina, Morena; Ferretti, Guido; Povolato, Michele.

In: International Journal of Radiation Oncology Biology Physics, Vol. 53, No. 5, 01.08.2002, p. 1303-1313.

Research output: Contribution to journalArticle

Campostrini, F, Gregianin, M, Rampin, L, Lonardi, F, De Lucchi, A, Coeli, M, Gioga, G, Prina, M, Ferretti, G & Povolato, M 2002, 'How iliopelvic lymphoscintigraphy can affect the definition of planning target volume in radiation therapy of pelvic and testicular tumors', International Journal of Radiation Oncology Biology Physics, vol. 53, no. 5, pp. 1303-1313. https://doi.org/10.1016/S0360-3016(02)02844-4
Campostrini, Franco ; Gregianin, Michele ; Rampin, Lucia ; Lonardi, Federico ; De Lucchi, Alessandro ; Coeli, Manuela ; Gioga, Gloria ; Prina, Morena ; Ferretti, Guido ; Povolato, Michele. / How iliopelvic lymphoscintigraphy can affect the definition of planning target volume in radiation therapy of pelvic and testicular tumors. In: International Journal of Radiation Oncology Biology Physics. 2002 ; Vol. 53, No. 5. pp. 1303-1313.
@article{8f7d6fbd61634490b68fec4a8f2d190e,
title = "How iliopelvic lymphoscintigraphy can affect the definition of planning target volume in radiation therapy of pelvic and testicular tumors",
abstract = "Purpose: External beam radiation therapy (EBRT) of most intrapelvic and testicular tumors has been generally performed with large fields encompassing both the primary disease and lymphatic drainage. This study was carried out to map the pelvic and periaortic lymphatics by means of iliopelvic lymphoscintigraphy (IPL) in preparation for radiotherapy planning. Methods and Materials: Between January 2000 and October 2001, 70 patients scheduled for EBRT (61 operated on, 52 females, 18 males, mean age 61, range, 24-80), affected with uterine (43), rectal (11), testicular (8), anal (4), penile (2), and vulvar (2) cancers were enrolled in the study. IPL was performed by injection of 99mtechnetium-nanocolloids in the bipedal (70 cases) or bipedal plus perianal (20 cases) sites. The sensitivity of IPL in mapping the lymphatic anatomy was evaluated first. Then three radiation oncologists scored the modifications induced by IPL on the planning target volume (PTV) which had been previously delineated only on the basis of bony landmarks. The original fields were classified {"}inadequate{"} if they failed to match the new PTV by more than 1 cm. Results: IPL sensitivity in showing the inguinal, external iliac, common, and periaortic lymphatics was 100{\%}, 90{\%}, 80{\%}, and 70{\%} in anterior-posterior (A-P) projections, and 100{\%}, 80{\%}, 70{\%}, and 60{\%} in lateral projections respectively. For the presacral and hypogastric ones the sensitivity was 40{\%}. When compared with bony landmarks, IPL changed the delineation of PTV in 24 of 70 A-P P-A fields (34{\%}) and 22 of 58 (38{\%}) lateral fields. Furthermore, 8/12 (67{\%}) lymphadenectomies resulted in being incomplete. No IPL-related toxicity was observed. Conclusion: IPL is a safe, inexpensive (cost: 100 Euros), and effective method to map the lymphatic chains. In the A-P scintigrams these structures were detected in 85{\%} (70-100{\%}) of the patients referred for total pelvis irradiation, and this figure could be higher in subjects not operated on. IPL can also give a reliable evaluation of the lymphadenectomies in order to schedule the proper treatments after surgery. Finally, IPL may change the conventional PTV for pelvic irradiation in about 36{\%} (34-38{\%}) of the cases; therefore, the fields should be tailored more around the lymphatic landmarks than the bony landmarks.",
keywords = "Lymphoscintigraphy, Mapping the lymph nodes, Pelvic radiotherapy, Pelvic tumors, Target volumes",
author = "Franco Campostrini and Michele Gregianin and Lucia Rampin and Federico Lonardi and {De Lucchi}, Alessandro and Manuela Coeli and Gloria Gioga and Morena Prina and Guido Ferretti and Michele Povolato",
year = "2002",
month = "8",
day = "1",
doi = "10.1016/S0360-3016(02)02844-4",
language = "English",
volume = "53",
pages = "1303--1313",
journal = "International Journal of Radiation Oncology Biology Physics",
issn = "0360-3016",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - How iliopelvic lymphoscintigraphy can affect the definition of planning target volume in radiation therapy of pelvic and testicular tumors

AU - Campostrini, Franco

AU - Gregianin, Michele

AU - Rampin, Lucia

AU - Lonardi, Federico

AU - De Lucchi, Alessandro

AU - Coeli, Manuela

AU - Gioga, Gloria

AU - Prina, Morena

AU - Ferretti, Guido

AU - Povolato, Michele

PY - 2002/8/1

Y1 - 2002/8/1

N2 - Purpose: External beam radiation therapy (EBRT) of most intrapelvic and testicular tumors has been generally performed with large fields encompassing both the primary disease and lymphatic drainage. This study was carried out to map the pelvic and periaortic lymphatics by means of iliopelvic lymphoscintigraphy (IPL) in preparation for radiotherapy planning. Methods and Materials: Between January 2000 and October 2001, 70 patients scheduled for EBRT (61 operated on, 52 females, 18 males, mean age 61, range, 24-80), affected with uterine (43), rectal (11), testicular (8), anal (4), penile (2), and vulvar (2) cancers were enrolled in the study. IPL was performed by injection of 99mtechnetium-nanocolloids in the bipedal (70 cases) or bipedal plus perianal (20 cases) sites. The sensitivity of IPL in mapping the lymphatic anatomy was evaluated first. Then three radiation oncologists scored the modifications induced by IPL on the planning target volume (PTV) which had been previously delineated only on the basis of bony landmarks. The original fields were classified "inadequate" if they failed to match the new PTV by more than 1 cm. Results: IPL sensitivity in showing the inguinal, external iliac, common, and periaortic lymphatics was 100%, 90%, 80%, and 70% in anterior-posterior (A-P) projections, and 100%, 80%, 70%, and 60% in lateral projections respectively. For the presacral and hypogastric ones the sensitivity was 40%. When compared with bony landmarks, IPL changed the delineation of PTV in 24 of 70 A-P P-A fields (34%) and 22 of 58 (38%) lateral fields. Furthermore, 8/12 (67%) lymphadenectomies resulted in being incomplete. No IPL-related toxicity was observed. Conclusion: IPL is a safe, inexpensive (cost: 100 Euros), and effective method to map the lymphatic chains. In the A-P scintigrams these structures were detected in 85% (70-100%) of the patients referred for total pelvis irradiation, and this figure could be higher in subjects not operated on. IPL can also give a reliable evaluation of the lymphadenectomies in order to schedule the proper treatments after surgery. Finally, IPL may change the conventional PTV for pelvic irradiation in about 36% (34-38%) of the cases; therefore, the fields should be tailored more around the lymphatic landmarks than the bony landmarks.

AB - Purpose: External beam radiation therapy (EBRT) of most intrapelvic and testicular tumors has been generally performed with large fields encompassing both the primary disease and lymphatic drainage. This study was carried out to map the pelvic and periaortic lymphatics by means of iliopelvic lymphoscintigraphy (IPL) in preparation for radiotherapy planning. Methods and Materials: Between January 2000 and October 2001, 70 patients scheduled for EBRT (61 operated on, 52 females, 18 males, mean age 61, range, 24-80), affected with uterine (43), rectal (11), testicular (8), anal (4), penile (2), and vulvar (2) cancers were enrolled in the study. IPL was performed by injection of 99mtechnetium-nanocolloids in the bipedal (70 cases) or bipedal plus perianal (20 cases) sites. The sensitivity of IPL in mapping the lymphatic anatomy was evaluated first. Then three radiation oncologists scored the modifications induced by IPL on the planning target volume (PTV) which had been previously delineated only on the basis of bony landmarks. The original fields were classified "inadequate" if they failed to match the new PTV by more than 1 cm. Results: IPL sensitivity in showing the inguinal, external iliac, common, and periaortic lymphatics was 100%, 90%, 80%, and 70% in anterior-posterior (A-P) projections, and 100%, 80%, 70%, and 60% in lateral projections respectively. For the presacral and hypogastric ones the sensitivity was 40%. When compared with bony landmarks, IPL changed the delineation of PTV in 24 of 70 A-P P-A fields (34%) and 22 of 58 (38%) lateral fields. Furthermore, 8/12 (67%) lymphadenectomies resulted in being incomplete. No IPL-related toxicity was observed. Conclusion: IPL is a safe, inexpensive (cost: 100 Euros), and effective method to map the lymphatic chains. In the A-P scintigrams these structures were detected in 85% (70-100%) of the patients referred for total pelvis irradiation, and this figure could be higher in subjects not operated on. IPL can also give a reliable evaluation of the lymphadenectomies in order to schedule the proper treatments after surgery. Finally, IPL may change the conventional PTV for pelvic irradiation in about 36% (34-38%) of the cases; therefore, the fields should be tailored more around the lymphatic landmarks than the bony landmarks.

KW - Lymphoscintigraphy

KW - Mapping the lymph nodes

KW - Pelvic radiotherapy

KW - Pelvic tumors

KW - Target volumes

UR - http://www.scopus.com/inward/record.url?scp=0036680576&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036680576&partnerID=8YFLogxK

U2 - 10.1016/S0360-3016(02)02844-4

DO - 10.1016/S0360-3016(02)02844-4

M3 - Article

VL - 53

SP - 1303

EP - 1313

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

SN - 0360-3016

IS - 5

ER -