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International consensus standardizes 3D target volumes for low-dose RT of tendinitis and bursitis

IBTVG experts defined reproducible CT-based GTV, CTV and PTV concepts for common tendinitis and bursitis sites treated with low-dose radiotherapy.

RadOncToday · ·1 min read

KEY POINTS

  • The International Benign Target Volume Group developed consensus target volumes using experts from 15 institutions across seven countries. The panel included 21 experts, with 18 participating in the initial contouring process, and consensus was predefined as ≥90% agreement on final anatomical boundaries.
  • Experts independently contoured a standardized CT-based 3D reference model across common indications including subacromial bursitis, biceps tendinitis, medial and lateral elbow tendinitis, de Quervain tendinitis, greater trochanteric pain syndrome, iliotibial band syndrome, patellar tendinopathy, Achilles tendinitis and plantar fasciitis.
  • The proposed framework defines the GTV as the region of clinical pain and inflammation, preferably supported by clinical examination and MRI when available. The CTV expands beyond visible disease to include involved tendon, muscle and insertion sites, extending up to 2 cm beyond a bone insertion and up to 3 cm along affected tendon or muscle depending on location.
  • PTV margins are anatomy- and setup-dependent rather than uniform. Across sites, CTV-to-PTV expansions ranged from approximately 0.2 to 1.5 cm, while a 0.2-cm margin from the skin should be maintained where feasible to avoid unnecessary skin irradiation and bolus.
  • Site-specific recommendations are deliberately anatomical. For lateral elbow tendinitis, the CTV extends approximately 5-6 cm distally along the extensor musculature and 1.5-2.0 cm proximally; for Achilles tendinitis, the CTV includes the calcaneal insertion and up to 6 cm of proximal Achilles tendon.
  • The consensus also establishes a standardized Cartesian coordinate system, consistent GTV/CTV/PTV nomenclature and indication-specific ICD-10 coding. The authors argue that this should make treatment volumes easier to reproduce, teach, audit and compare between institutions.
  • Importantly, this is a target-definition consensus, not evidence that low-dose radiotherapy is clinically effective. The authors acknowledge that high-quality sham-controlled evidence for tendinopathies remains limited and position these standardized volumes as infrastructure for future prospective trials.

CLINICAL TAKEAWAY

For centres already offering low-dose radiotherapy for refractory tendinitis or bursitis, this paper provides a much more reproducible 3D planning framework than traditional field-based approaches. It may improve consistency and radiation protection, but it should not be interpreted as establishing the efficacy of low-dose radiotherapy for these conditions.

SOURCE

International Journal of Radiation Oncology, Biology, Physics

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