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Pract Radiat Oncol. 2015 Nov-Dec;5(6):e557-65. doi: 10.1016/j.prro.2015.06.011. Epub 2015 Jul 2.

Variability in clinical target volume delineation for intensity modulated radiation therapy in 3 challenging cervix cancer scenarios.

Author information

1
Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, NSW, Australia.
2
Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
3
Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
4
Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.
5
Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
6
Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
7
Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida.
8
Department of Radiation Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
9
Washington University School of Medicine, St. Louis, Missouri.
10
Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama.
11
Department of Radiation Medicine and Applied Sciences, University of California, San Diego, School of Medicine, La Jolla, California.
12
Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina.
13
Department of Radiation Oncology, McGill University Health Center, Montreal, QC, Canada.
14
Epworth Radiation Oncology, Epworth Healthcare, Melbourne, Victoria, Melbourne, VIC, Australia.
15
Radiation Medicine Program, Princess Margaret Hospital/Ontario Cancer Institute, University Health Network, Toronto, ON, Canada. Electronic address: Anthony.Fyles@rmp.uhn.on.ca.

Abstract

PURPOSE:

The purpose of this study was to assess variability in contouring the gross tumor volume (GTV) and clinical target volume (CTV) of 3 clinical cervix cancer cases by a cohort of international experts in the field in preparation for the development of an online teaching atlas.

METHODS AND MATERIALS:

Twelve international experts participated. Three clinical scenarios: node positivity (PLN), retroverted uterus (RV), and parametrial invasion (PI) were used. Sagittal and axial magnetic resonance images of the clinical cases were downloaded to participants' treatment planning systems for contouring. The GTV/cervix/uterus/parametria/vagina and nodal CTV were contoured. Contour consensus was assessed for sensitivity/specificity using an expectation maximization algorithm called Simultaneous Truth and Performance Level Estimation and experts' overall agreement was summarized by kappa statistics.

RESULTS:

Agreement for GTV in the 3 clinical cases was high (Simultaneous Truth and Performance Level Estimation sensitivity, 0.54-0.92; specificity, 0.97-0.98; and kappa measure for PLN, RV, and PI was 0.86, 0.76, and 0.42; P < .0001). Moderate to substantial agreement was seen for nodal CTV (kappa statistics for PLN, RV, and PI was 0.65, 0.58, and 0.62; P < .0001), uterus (kappa for PLN, RV, and PI was 0.45, 0.74, and 0.77; P < .0001), and parametria (kappa for PLN, RV, and PI was 0.49, 0.62, and 0.50; P < .0001). Contouring heterogeneity was greatest for the cervix (kappa measure for PLN, RV, and PI was 0.15, 0.4, and 0.24; P < .0001) and vagina (kappa for PLN, RV, and PI was 0.47, 0.36 and 0.46; P < .0001), reflecting difficulties in determining the interface between GTV and these tissues.

CONCLUSION:

Kappa statistics of the different CTV components generally demonstrated moderate to substantial agreement among international experts in the field of gynecological radiation therapy. Further planning target volume margins accounting for organ motion and setup errors are a necessary addition to the CTV.

PMID:
26432679
PMCID:
PMC4884648
DOI:
10.1016/j.prro.2015.06.011
[Indexed for MEDLINE]
Free PMC Article

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