A simplified CT-based definition of the lymph node levels in the node negative neck

Oda B. Wijers, Peter C. Levendag, Terence Tan, Erik B. Van Dieren, John Van Sörnsen De Koste, Henri Van Der Est, Suresh Senan, Peter J.C.M. Nowak

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Introduction and purpose: Using three dimensional (3D) conformal radiotherapy (CRT) techniques for elective neck irradiation (ENI) may allow for local disease control to be maintained while diminishing xerostomia by eliminating major salivary glands (or parts thereof) from the treatment portals. The standardization of CT based target volumes for the clinically negative (elective) neck is a prerequisite for 3DCRT. The aim of the present study was to substantially modify an existing ('original') CT-based protocol for the delineation of the neck target volume, into a more practical ('simplified') protocol. This will allow for rapid contouring and the implementation of conformal ENI in routine clinical procedures. Material and Methods: An earlier ('original') version of the CT-based definition for elective neck node regions 2-5 was re-evaluated, using 15 planning CT scans of previously treated patients. The contouring guidelines were simplified by (1) using a smaller number of easily identifiable soft tissue- and bony anatomical landmarks, which in turn had to be identified in only a limited number of CT slices, and (2) by subsequently interpolating the contoured lymph node regions. The adequacy of target coverage and the sparing using both 'original' and 'simplified' delineation protocols was evaluated by DVH analysis after contouring the primary tumor, the neck and the major salivary glands in a patient with supraglottic laryngeal (SGL) carcinoma who was treated using a 3DCRT technique. Results: The BEV projections of the 'original' and the 'simplified' versions of the 3D elective neck target showed good agreement and were found to be reproducible. The DVH's of the target and parotid glands were not significantly different using both contouring protocols. Conclusions: The 'simplified' protocol for the delineation of the 3D elective neck target produced both comparable target coverage and sparing of the major salivary glands. When used together with an interpolation program, this 'simplified' protocol substantial reduced the contouring time and makes ENI with sparing of the major salivary glands a practical and achievable goal.

Original languageEnglish
Pages (from-to)35-42
Number of pages8
JournalRadiotherapy and Oncology
Volume52
Issue number1
DOIs
Publication statusPublished - 1 Jul 1999

Cite this

Wijers, O. B., Levendag, P. C., Tan, T., Van Dieren, E. B., Van Sörnsen De Koste, J., Van Der Est, H., ... Nowak, P. J. C. M. (1999). A simplified CT-based definition of the lymph node levels in the node negative neck. Radiotherapy and Oncology, 52(1), 35-42. https://doi.org/10.1016/S0167-8140(99)00076-6
Wijers, Oda B. ; Levendag, Peter C. ; Tan, Terence ; Van Dieren, Erik B. ; Van Sörnsen De Koste, John ; Van Der Est, Henri ; Senan, Suresh ; Nowak, Peter J.C.M. / A simplified CT-based definition of the lymph node levels in the node negative neck. In: Radiotherapy and Oncology. 1999 ; Vol. 52, No. 1. pp. 35-42.
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abstract = "Introduction and purpose: Using three dimensional (3D) conformal radiotherapy (CRT) techniques for elective neck irradiation (ENI) may allow for local disease control to be maintained while diminishing xerostomia by eliminating major salivary glands (or parts thereof) from the treatment portals. The standardization of CT based target volumes for the clinically negative (elective) neck is a prerequisite for 3DCRT. The aim of the present study was to substantially modify an existing ('original') CT-based protocol for the delineation of the neck target volume, into a more practical ('simplified') protocol. This will allow for rapid contouring and the implementation of conformal ENI in routine clinical procedures. Material and Methods: An earlier ('original') version of the CT-based definition for elective neck node regions 2-5 was re-evaluated, using 15 planning CT scans of previously treated patients. The contouring guidelines were simplified by (1) using a smaller number of easily identifiable soft tissue- and bony anatomical landmarks, which in turn had to be identified in only a limited number of CT slices, and (2) by subsequently interpolating the contoured lymph node regions. The adequacy of target coverage and the sparing using both 'original' and 'simplified' delineation protocols was evaluated by DVH analysis after contouring the primary tumor, the neck and the major salivary glands in a patient with supraglottic laryngeal (SGL) carcinoma who was treated using a 3DCRT technique. Results: The BEV projections of the 'original' and the 'simplified' versions of the 3D elective neck target showed good agreement and were found to be reproducible. The DVH's of the target and parotid glands were not significantly different using both contouring protocols. Conclusions: The 'simplified' protocol for the delineation of the 3D elective neck target produced both comparable target coverage and sparing of the major salivary glands. When used together with an interpolation program, this 'simplified' protocol substantial reduced the contouring time and makes ENI with sparing of the major salivary glands a practical and achievable goal.",
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A simplified CT-based definition of the lymph node levels in the node negative neck. / Wijers, Oda B.; Levendag, Peter C.; Tan, Terence; Van Dieren, Erik B.; Van Sörnsen De Koste, John; Van Der Est, Henri; Senan, Suresh; Nowak, Peter J.C.M.

In: Radiotherapy and Oncology, Vol. 52, No. 1, 01.07.1999, p. 35-42.

Research output: Contribution to journalArticleAcademicpeer-review

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T1 - A simplified CT-based definition of the lymph node levels in the node negative neck

AU - Wijers, Oda B.

AU - Levendag, Peter C.

AU - Tan, Terence

AU - Van Dieren, Erik B.

AU - Van Sörnsen De Koste, John

AU - Van Der Est, Henri

AU - Senan, Suresh

AU - Nowak, Peter J.C.M.

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AB - Introduction and purpose: Using three dimensional (3D) conformal radiotherapy (CRT) techniques for elective neck irradiation (ENI) may allow for local disease control to be maintained while diminishing xerostomia by eliminating major salivary glands (or parts thereof) from the treatment portals. The standardization of CT based target volumes for the clinically negative (elective) neck is a prerequisite for 3DCRT. The aim of the present study was to substantially modify an existing ('original') CT-based protocol for the delineation of the neck target volume, into a more practical ('simplified') protocol. This will allow for rapid contouring and the implementation of conformal ENI in routine clinical procedures. Material and Methods: An earlier ('original') version of the CT-based definition for elective neck node regions 2-5 was re-evaluated, using 15 planning CT scans of previously treated patients. The contouring guidelines were simplified by (1) using a smaller number of easily identifiable soft tissue- and bony anatomical landmarks, which in turn had to be identified in only a limited number of CT slices, and (2) by subsequently interpolating the contoured lymph node regions. The adequacy of target coverage and the sparing using both 'original' and 'simplified' delineation protocols was evaluated by DVH analysis after contouring the primary tumor, the neck and the major salivary glands in a patient with supraglottic laryngeal (SGL) carcinoma who was treated using a 3DCRT technique. Results: The BEV projections of the 'original' and the 'simplified' versions of the 3D elective neck target showed good agreement and were found to be reproducible. The DVH's of the target and parotid glands were not significantly different using both contouring protocols. Conclusions: The 'simplified' protocol for the delineation of the 3D elective neck target produced both comparable target coverage and sparing of the major salivary glands. When used together with an interpolation program, this 'simplified' protocol substantial reduced the contouring time and makes ENI with sparing of the major salivary glands a practical and achievable goal.

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KW - CT

KW - Lymph node levels

KW - Lymph nodes

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