TY - JOUR
T1 - Mapping of local recurrence after pancreaticoduodenectomy for distal extrahepatic cholangiocarcinoma
T2 - Implications for adjuvant radiotherapy
AU - Jung, Wonguen
AU - Kim, Kyubo
AU - Min, Seog Ki
AU - Nam, Eun Mi
AU - Lee, Jeong Kyong
N1 - Publisher Copyright:
© 2019 The Authors.
PY - 2019
Y1 - 2019
N2 - Objective: To generate a map of local recurrences after pancreaticoduodenectomy (PD) for patients with distal extrahepatic cholangiocarcinoma (DEHC) and to evaluate the adequate target volume coverage encompassing the majority of local recurrences when the clinical target volume (CTV) for pancreatic cancer was applied. Methods: We retrospectively reviewed the records of DEHC patients who underwent pancreaticoduodenec-tomy and had postoperative CT scans acquired between 1991 and 2015 available. The sites of local recurrence were delineated on individual CT scans, and then, mapping was manually performed onto template CT images. Coverage of each site of local recurrence was evaluated by applying the CTV defned according to Radiation Therapy Oncology Group (RTOG) consensus guidelines (CTVRTOG ) for target delineation in the postoperative treatment of pancreatic head cancer. results: Of the 99 patients, 36 patients had a total of 62 local relapses identifable by postoperative CT scans; the relapses were the most frequent in the choledocho-jejunostomy (CJ) site, 11 sites (17.7%); para-aortic area, 10 sites (16.1%), superior mesenteric artery area, 10 sites (16.1%); and portal vein area, 9 sites (14.5%). 21 sites (33.9%) were not covered by the CTVRTOG, and the most common site of local recurrence outside the CTVRTOG was the CJ site. conclusion: When mapping of local relapses was evaluated according to the CTVRTOG, the choledochojeju-nostomy site was identifed as a high-risk area of local recurrence but was insufciently covered within the CTVRTOG. These fndings may help construct a target volume for postoperative radiotherapy in DEHC. advances in knowledge: Mapping local recurrences can aid in defning appropriate target volume for postoperative radiotherapy in DEHC.
AB - Objective: To generate a map of local recurrences after pancreaticoduodenectomy (PD) for patients with distal extrahepatic cholangiocarcinoma (DEHC) and to evaluate the adequate target volume coverage encompassing the majority of local recurrences when the clinical target volume (CTV) for pancreatic cancer was applied. Methods: We retrospectively reviewed the records of DEHC patients who underwent pancreaticoduodenec-tomy and had postoperative CT scans acquired between 1991 and 2015 available. The sites of local recurrence were delineated on individual CT scans, and then, mapping was manually performed onto template CT images. Coverage of each site of local recurrence was evaluated by applying the CTV defned according to Radiation Therapy Oncology Group (RTOG) consensus guidelines (CTVRTOG ) for target delineation in the postoperative treatment of pancreatic head cancer. results: Of the 99 patients, 36 patients had a total of 62 local relapses identifable by postoperative CT scans; the relapses were the most frequent in the choledocho-jejunostomy (CJ) site, 11 sites (17.7%); para-aortic area, 10 sites (16.1%), superior mesenteric artery area, 10 sites (16.1%); and portal vein area, 9 sites (14.5%). 21 sites (33.9%) were not covered by the CTVRTOG, and the most common site of local recurrence outside the CTVRTOG was the CJ site. conclusion: When mapping of local relapses was evaluated according to the CTVRTOG, the choledochojeju-nostomy site was identifed as a high-risk area of local recurrence but was insufciently covered within the CTVRTOG. These fndings may help construct a target volume for postoperative radiotherapy in DEHC. advances in knowledge: Mapping local recurrences can aid in defning appropriate target volume for postoperative radiotherapy in DEHC.
UR - http://www.scopus.com/inward/record.url?scp=85070055328&partnerID=8YFLogxK
U2 - 10.1259/bjr.20190285
DO - 10.1259/bjr.20190285
M3 - Article
C2 - 31145644
AN - SCOPUS:85070055328
SN - 0007-1285
VL - 92
JO - British Journal of Radiology
JF - British Journal of Radiology
IS - 1100
M1 - 20190285
ER -