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Int J Radiat Oncol Biol Phys. 2016 Jul 15;95(4):1191-200. doi: 10.1016/j.ijrobp.2016.02.043. Epub 2016 Feb 21.

Consensus Recommendations for Radiation Therapy Contouring and Treatment of Vulvar Carcinoma.

Author information

1
Department of Radiation Oncology, Huntsman Cancer Hospital, Salt Lake City, Utah. Electronic address: david.gaffney@hci.utah.edu.
2
Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre and Epworth Radiation Oncology, Melbourne, Victoria, Australia.
3
Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts.
4
Department of Radiation Oncology, Centre hospitalier de l'universite de Montreal, Montreal, Quebec, Canada.
5
Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
6
Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
7
Department of Radiation Oncology, Proedtert and Medical College Clinical Cancer Center, Milwaukee, Wisconsin.
8
Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
9
Department of Radiation Oncology, British Columbia Cancer Agency, Victoria, British Columbia, Canada.
10
Department of Radiation Oncology, Stritch School of Medicine, Loyola University, Maywood, Illinois.
11
Department of Radiation Oncology, University of Washington, Seattle, Washington.
12
Liverpool Cancer Therapy Centre, Radiation Oncology Unit, Sydney, New South Wales, Australia.
13
Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
14
Radiation Oncology Department, Miller School of Medicine, University of Miami, Miami, Florida.
15
St. Luke's Cancer Centre, Royal Surrey Country Hospital, Surrey, United Kingdom.
16
Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada.
17
Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California.
18
Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.

Abstract

PURPOSE:

The purpose of this study was to develop a radiation therapy (RT) contouring atlas and recommendations for women with postoperative and locally advanced vulvar carcinoma.

METHODS AND MATERIALS:

An international committee of 35 expert gynecologic radiation oncologists completed a survey of the treatment of vulvar carcinoma. An initial set of recommendations for contouring was discussed and generated by consensus. Two cases, 1 locally advanced and 1 postoperative, were contoured by 14 physicians. Contours were compared and analyzed using an expectation-maximization algorithm for simultaneous truth and performance level estimation (STAPLE), and a 95% confidence interval contour was developed. The level of agreement among contours was assessed using a kappa statistic. STAPLE contours underwent full committee editing to generate the final atlas consensus contours.

RESULTS:

Analysis of the 14 contours showed substantial agreement, with kappa statistics of 0.69 and 0.64 for cases 1 and 2, respectively. There was high specificity for both cases (≥99%) and only moderate sensitivity of 71.3% and 64.9% for cases 1 and 2, respectively. Expert review and discussion generated consensus recommendations for contouring target volumes and treatment for postoperative and locally advanced vulvar cancer.

CONCLUSIONS:

These consensus recommendations for contouring and treatment of vulvar cancer identified areas of complexity and controversy. Given the lack of clinical research evidence in vulvar cancer radiation therapy, the committee advocates a conservative and consistent approach using standardized recommendations.

PMID:
27130794
PMCID:
PMC5189987
DOI:
10.1016/j.ijrobp.2016.02.043
[Indexed for MEDLINE]
Free PMC Article

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