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Recommendations for MRI-based contouring of gross tumor volume and organs at risk for radiation therapy of pancreatic cancer. Pract Radiat Oncol 2017 Mar - Apr;7(2):126-136 PMID: 28089481

Pubmed ID





PURPOSE: Local recurrence is a common and morbid event in patients with unresectable pancreatic adenocarcinoma. A more conformal and targeted radiation dose to the macroscopic tumor in nonmetastatic pancreatic cancer is likely to reduce acute toxicity and improve local control. Optimal soft tissue contrast is required to facilitate delineation of a target and creation of a planning target volume with margin reduction and motion management. Magnetic resonance imaging (MRI) offers considerable advantages in optimizing soft tissue delineation and is an ideal modality for imaging and delineating a gross tumor volume (GTV) within the pancreas, particularly as it relates to conformal radiation planning. Currently, no guidelines have been defined for the delineation of pancreatic tumors for radiation therapy treatment planning. Moreover, abdominal MRI sequences are complex and the anatomy relevant to the radiation oncologist can be challenging. The purpose of this study is to provide recommendations for delineation of GTV and organs at risk (OARs) using MRI and incorporating multiple MRI sequences.

METHODS AND MATERIALS: Five patients with pancreatic cancer and 1 healthy subject were imaged with MRI scans either on 1.5T or on 3T magnets in 2 separate institutes. The GTV and OARs were contoured for all patients in a consensus meeting.

RESULTS: An overview of MRI-based anatomy of the GTV and OARs is provided. Practical contouring instructions for the GTV and the OARs with the aid of MRI were developed and included in these recommendations. In addition, practical suggestions for implementation of MRI in pancreatic radiation treatment planning are provided.

CONCLUSIONS: With this report, we attempt to provide recommendations for MRI-based contouring of pancreatic tumors and OARs. This could lead to better uniformity in defining the GTV and OARs for clinical trials and in radiation therapy treatment planning, with the ultimate goal of improving local control while minimizing morbidity.

Author List

Heerkens HD, Hall WA, Li XA, Knechtges P, Dalah E, Paulson ES, van den Berg CA, Meijer GJ, Koay EJ, Crane CH, Aitken K, van Vulpen M, Erickson BA


Beth A. Erickson MD Professor in the Radiation Oncology department at Medical College of Wisconsin
William Adrian Hall MD Assistant Professor in the Radiation Oncology department at Medical College of Wisconsin
X Allen Li PhD Professor in the Radiation Oncology department at Medical College of Wisconsin
Eric Paulson PhD Associate Professor in the Radiation Oncology department at Medical College of Wisconsin


2-s2.0-85009476334   6 Citations

MESH terms used to index this publication - Major topics in bold

Aged, 80 and over
Magnetic Resonance Imaging
Neoplasm Recurrence, Local
Neoplasm Staging
Organs at Risk
Pancreatic Neoplasms
Practice Guidelines as Topic
Radiation Dosage
Radiotherapy Planning, Computer-Assisted
Radiotherapy, Conformal
Tomography, X-Ray Computed
Tumor Burden
Young Adult
jenkins-FCD Prod-332 f92a19b0ec5e8e1eff783fac390ec127e367c2b5