Delineation variation of lymph node stations for treatment planning in lung cancer radiotherapy

Kępka, Lucyna; Bujko, Krzysztof; Garmol, Dariusz; Pałucki, Jakub; Żółciak-Siwińska, Agnieszka; Guzel-Szczepiórkowska, Z.; Pietrzak, L.; Komosinska, Katarzyna; Sprawka, Arkadiusz; Garbaczewska, A.

doi:10.1016/j.radonc.2007.10.028

Cited by 43 publications

(43 citation statements)

References 16 publications

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“…Generously contoured structures may be less likely to exclude any of the reference structures, and can achieve better GMI scores [22], whereas the DI is useful to highlight incorrectly large target structures, i.e. “too much unnecessary volume” [23]. In our data the GTV volume correlated strongly with DI ( p < 0.001), as expected, however GTV volume did not show a strong negative correlation with GMI, suggesting that generous contouring did not lead to improved tumour coverage.…”

Section: Discussionmentioning

confidence: 99%

Conformity analysis to demonstrate reproducibility of target volumes for Margin-Intense Stereotactic Radiotherapy for borderline-resectable pancreatic cancer

Holyoake

Robinson

Grose

et al. 2016

Radiotherapy and Oncology

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Background and purposeMargin-directed neoadjuvant radiotherapy for borderline-resectable pancreatic cancer (BRPC) aims to facilitate clear surgical margins. A systematic method was developed for definition of a boost target volume prior to a formal phase-I study.Material and methodsReference structures were defined by two oncologists and one radiologist, target structures were submitted by eight oncologist investigators and compared using conformity indices. Resultant risk of duodenal bleed (NTCP) was modelled.ResultsFor GTV, reference volume was 2.1 cm3 and investigator mean was 6.03 cm3 (95% CI 3.92–8.13 cm3), for boost volume 1.1 cm3 and 1.25 cm3 (1.02–1.48 cm3). Mean Dice conformity coefficient for GTV was 0.47 (0.38–0.56), and for boost volume was significantly higher at 0.61 (0.52–0.70, p = 0.01). Discordance index (DI) for GTV was 0.65 (0.56–0.75) and for boost volume was significantly lower at 0.39 (0.28–0.49, p = 0.001). NTCP using reference contours was 2.95%, with mean for investigator contour plans 3.93% (3.63–4.22%). Correlations were seen between NTCP and GTV volume (p = 0.02) and NTCP and DI (correlation coefficient 0.83 (0.29–0.97), p = 0.01).ConclusionsBetter conformity with reference was shown for boost volume compared with GTV. Investigator GTV volumes were larger than reference, had higher DI scores and modelled toxicity risk. A consistent method of target structure definition for margin-directed pancreatic radiotherapy is demonstrated.

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Section: Discussionmentioning

confidence: 99%

Conformity analysis to demonstrate reproducibility of target volumes for Margin-Intense Stereotactic Radiotherapy for borderline-resectable pancreatic cancer

Holyoake

Robinson

Grose

et al. 2016

Radiotherapy and Oncology

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“…The reduction of these margins could be related to the course, which clarified the delineation using matched CT-PET, and addressed the principles and advantages of the treatment technique (respiratory gating) and better knowledge of thoracic anatomy [3,14]. Guidelines in lung cancer delineation have long been known [15-17]. Lung cancer, like head and neck, is often used as an example in teaching.…”

Section: Discussionmentioning

confidence: 99%

“…Delineation variability has already been analyzed, in prostate cancer [18,19], breast cancer [20], lung cancer [15], and cervical cancer [21]. Optimizing delineation may be done in several ways.…”

Section: Discussionmentioning

confidence: 99%

“…Another way to standardize delineation is the creation of atlas support, available online or on paper. More and more locations are referenced, including head-and-neck cancer [25], gynecological [26], prostate [19,27], and lung cancer [15,16]. Based on this principle, a delineation self-training website has also been introduced in France since October 2008 http://www.siriade.org.…”

Section: Discussionmentioning

confidence: 99%

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Delineation in thoracic oncology: a prospective study of the effect of training on contour variability and dosimetric consequences

et al. 2011

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IntroductionAs part of French residents' radiotherapy training, delineation workstations were available at a national teaching course. We report a prospective comparative study of a non small cell lung cancer (NSCLC) case delineated by 120 residents before and after a radioanatomy/radiotherapy lecture.Materials and methodsThe case of a patient with right upper lobe non small cell lung cancer (NSCLC) was provided for delineation to 32 groups of residents before and after a radiation therapy lecture about thoracic delineation. GTV, CTV and PTV was asked to each group. In a second step, the GTV, CTV and PTV were compared with those of 9 groups of senior physicians. Finally the consequences for treatment planning between each group before and after the course were explored.ResultsThe expert's average GTV, CTV and PTV were 89.1 cm3, 242.3 cm3 and 293.9 cm3 respectively. For residents, those volumes were 103.4 cm3, 242.3 cm3 and 457.9 cm3 before teaching, compared to 99.5 cm3, 224.2 cm3 and 412.5 cm3 after teaching. The overlap (OV) and kappa (KI) indices before and after education were respectively 0.58 and 0.73. Compared to senior physicians, OV and KI indices were lower in the residents group (p = 0.039 and p = 0.043). An increased dose to the lung is noted for the residents' dosimetry compared to the experts' (V20: 23.2% versus 36.5%) due to the larger PTV delineated. No significant difference was observed for other organs at risk.ConclusionThere were no significant differences for the delineation of the GTV and CTV before and after the course, although the differences tended to decrease after the course. The good initial quality of the contours could explain the lack of difference. V20 for lung was higher in the residents group compared to the experts group (23.2% vs 36.5%). No other treatment planning consequences were observed for other critical organs.

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“…8,11,13,[23][24][25] A recent study suggested that delineation variation may be smaller in peripheral lung tumors referred for SBRT in a single-institutional setting. 26 In all these studies, participants delineated structures on a common radiological data set, and interobserver variation was quantified using various parameters involving distribution of volumes, overlap between contoured volumes, and statistical measures of agreement.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Peer Review of Volume Delineation in Stereotactic Body Radiation Therapy Planning for Primary Lung Cancer: A Multicenter Quality Assurance Study

Liu

Chan

et al. 2014

Journal of Thoracic Oncology

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Delineation variation of lymph node stations for treatment planning in lung cancer radiotherapy

Cited by 43 publications

References 16 publications

Conformity analysis to demonstrate reproducibility of target volumes for Margin-Intense Stereotactic Radiotherapy for borderline-resectable pancreatic cancer

Conformity analysis to demonstrate reproducibility of target volumes for Margin-Intense Stereotactic Radiotherapy for borderline-resectable pancreatic cancer

Delineation in thoracic oncology: a prospective study of the effect of training on contour variability and dosimetric consequences

The Impact of Peer Review of Volume Delineation in Stereotactic Body Radiation Therapy Planning for Primary Lung Cancer: A Multicenter Quality Assurance Study

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