Development and Validation of Consensus Contouring Guidelines for Adjuvant Radiation Therapy for Bladder Cancer After Radical Cystectomy

To develop multi-institutional consensus clinical target volumes (CTVs) and organs at risk (OARs) for male and female bladder cancer patients undergoing adjuvant radiation therapy (RT) in clinical trials.

We convened a multidisciplinary group of bladder cancer specialists from 15 centers and 5 countries. Six radiation oncologists and 7 urologists participated in the development of the initial contours. The group proposed initial language for the CTVs and OARs, and each radiation oncologist contoured them on computed tomography scans of a male and female cystectomy patient with input from ≥1 urologist. On the basis of the initial contouring, the group updated its CTV and OAR descriptions. The cystectomy bed, the area of greatest controversy, was contoured by another 6 radiation oncologists, and the cystectomy bed contouring language was again updated. To determine whether the revised language produced consistent contours, CTVs and OARs were redrawn by 6 additional radiation oncologists. We evaluated their contours for level of agreement using the Landis-Koch interpretation of the κ statistic.

The group proposed that patients at elevated risk for local-regional failure with negative margins should be treated to the pelvic nodes alone (internal/external iliac, distal common iliac, obturator, and presacral), whereas patients with positive margins should be treated to the pelvic nodes and cystectomy bed. Proposed OARs included the rectum, bowel space, bone marrow, and urinary diversion. Consensus language describing the CTVs and OARs was developed and externally validated. The revised instructions were found to produce consistent contours.

Consensus descriptions of CTVs and OARs were successfully developed and can be used in clinical trials of adjuvant radiation therapy for bladder cancer.

International journal of radiation oncology, biology, physics. 2016 May 07 [Epub]

Brian C Baumann, Walter R Bosch, Amit Bahl, Alison J Birtle, Rodney H Breau, Amarnath Challapalli, Albert J Chang, Ananya Choudhury, Sia Daneshmand, Ali El-Gayed, Adam Feldman, Steven E Finkelstein, Thomas J Guzzo, Serena Hilman, Ashesh Jani, S Bruce Malkowicz, Constantine A Mantz, Viraj Master, Anita V Mitra, Vedang Murthy, Sima P Porten, Pierre M Richaud, Paul Sargos, Jason A Efstathiou, Libni J Eapen, John P Christodouleas

Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania., Washington University in St. Louis, St. Louis, Missouri., University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom., Royal Preston Hospital, Preston, United Kingdom., University of Ottawa, Ottawa, Ontario, Canada., University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom., University of California San Francisco, San Francisco, California., Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The University of Manchester, Manchester Academic Heath Science Centre, Manchester, United Kingdom., University of Southern California, Los Angeles, California., Saskatoon Cancer Centre, Saskatoon, Canada., Massachusetts General Hospital, Boston, Massachusetts., Cancer Treatment Centers of America, Tulsa, Oklahoma., Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania., University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom., Emory University, Atlanta, Georgia., Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania., 21(st) Century Oncology, Scottsdale, Arizona; 21st Century Oncology, Fort Myers, Florida., Emory University, Atlanta, Georgia., University College London Hospital, London, United Kingdom., Tata Memorial Center, Mumbai, India., University of California San Francisco, San Francisco, California., Institut Bergonié, Bordeaux, France., Institut Bergonié, Bordeaux, France., Massachusetts General Hospital, Boston, Massachusetts., University of Ottawa, Ottawa, Ontario, Canada., Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: .