International consensus guidelines on Clinical Target Volume delineation in rectal cancer

Vincenzo Valentini, Maria Antonietta Gambacorta, Brunella Barbaro, Giuditta Chiloiro, Claudio Coco, Prajnan Das, Francesco Fanfani, Ines Joye, Lisa Kachnic, Philippe Maingon, Corrie Marijnen, Samuel Ngan, Karin Haustermans

Research output: Contribution to journalArticlepeer-review


Introduction The delineation of Clinical Target Volume (CTV) is a critical step in radiotherapy. Several guidelines suggest different subvolumes and anatomical boundaries in rectal cancer (RC), potentially leading to a misunderstanding in the CTV definition. International consensus guidelines (CG) are needed to improve uniformity in RC CTV delineation. Material and methods The 7 radiation oncologist experts defined a roadmap to produce RC CG. Step 1: revision of the published guidelines. Step 2: selection of RC cases with different clinical stages. Step 3: delineation of cases using Falcon following previously published guidelines. Step 4: meeting in person to discuss the initial delineation outcome, followed by a CTV proposal based on revised and if needed, adapted anatomical boundaries. Step 5: peer review of the agreed consensus. Step 6: peer review meeting to validate the final outcome. Step 7: completion of RC delineation atlases. Results A new ontology of structure sets was defined and the related table of anatomical boundaries was generated. The major modifications were about the lateral lymph nodes and the ischio-rectal fossa delineation. Seven RC cases were made available online as consultation atlases. Conclusion The definition of international CG for RC delineation endorsed by international experts might support a future homogeneous comparison between clinical trial outcomes.

Original languageEnglish
Pages (from-to)195-201
Number of pages7
JournalRadiotherapy and Oncology
Issue number2
Publication statusPublished - Aug 1 2016


  • Clinical Target Volume delineation
  • Consensus guidelines
  • Rectal cancer

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging


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