Anatomically accurate.

The pandemic seems to have given several international working groups time to update their contouring guidelines. The NRG prostate cancer group has outdone themselves with tthis update of the 2009 prostate pelvic node contouring atlas. The overarching themes are a move to using vascular anatomy (rather than bony landmarks) and refinement/expansion of the prior target volume limits to reflect more recent surgical and advanced imaging analyses of nodal metastases. There’s a handy 10-step process for delineating standard nodal volumes. There’s also a table to help identify suspicious lymph nodes. There are recommendations for how to include involved nodes and a supplemental atlas with more expansive volumes for advanced disease. Finally, there’s an amazing table of dose constraints adapted for nodal coverage for conventional fractionation and both the 20 and 28 fraction hypofractionated regimens. TBL: If you’re inclined to include pelvic lymph node coverage for prostate cancer, the 2020 update of the NRG Prostate Pelvic Node Atlas is a must-have. | Hall, Int J Radiat Oncol Biol Phys 2020