Clinical target volume delineation including elective nodal irradiation in preoperative and definitive radiotherapy of pancreatic cancer (Radiation Oncology)

Background: Radiotherapy is widely used in the treatment of pancreatic cancer. Currently,recommendation has been given for the delineation of the clinical target volume (CTV) inadjuvant radiotherapy. Based on recently reviewed pathologic data, the aim of this study is topropose criteria for the CTV definition and delineation including elective nodal irradiation(ENI) in the preoperative and definitive treatment of pancreatic cancer. Methods: The anatomical structures of interest, as well as the abdominal vasculature were identified onintravenous contrast-enhanced CT scans of two different patients with pancreatic cancer ofthe head and the body. To delineate the lymph node area, a margin of 10 mm was added tothe arteries. Results: We proposed a set of guidelines for elective treatment of high-risk nodal areas and CTVdelineation. Reference CT images were provided. Conclusions: The proposed guidelines could be used for preoperative or definitive radiotherapy (RT) forcarcinoma of the head and body of the pancreas. Further clinical investigations are needed tovalidate the defined CTVs.