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Title: Comprehensive Quantitative Evaluation of Variability in MR-guided Delineation of Oropharyngeal Gross Tumor Volumes and High-risk Clinical Target Volumes: An R-IDEAL Stage 0 Prospective Study.
Austin Authors: Cardenas, Carlos E;Blinde, Sanne E;Mohamed, Abdallah S R;Ng, Sweet Ping ;Raaijmakers, Cornelis;Philippens, Marielle;Kotte, Alexis;Al-Mamgani, Abrahim A;Karam, Irene;Thomson, David J;Robbins, Jared;Newbold, Kate;Fuller, Clifton D;Terhaard, Chris;On Behalf Of The, null;Bahig, Houda;Blanchard, Pierre;Dehnad, Homan;Doornaert, Patricia;Elhalawani, Hesham;Frank, Steven J;Garden, Adam;Gunn, G Brandon;Hamming-Vrieze, Olga;Kamal, Mona;Kasperts, Nicolien;Lee, Lip Wai;McDonald, Brigid A;McPartlin, Andrew;Meheissen, Mohamed Am;Morrison, William H;Navran, Arash;Nutting, Christopher M;Pameijer, Frank;Phan, Jack;Poon, Ian;Rosenthal, David I;Smid, Ernst J;Sykes, Andrew J
Affiliation: Olivia Newton-John Cancer Research Institute
Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, AL, USA
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
Department of Radiation Oncology, University of Arizona, Tucson, Arizona, USA
Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
Department of Radiation Oncology, Klinikum Kassel, Kassel, Germany
Department of Radiotherapy, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
Alexandria Clinical Oncology Department, Alexandria University, Alexandria, Egypt
Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
Department of Radiology, Division of Imaging & Oncology, University Medical Center, Utrecht, The Netherlands
Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON, Canada
Issue Date: 3-Jun-2022
Date: 2022-02-04
Publication information: International Journal of Radiation Oncology, Biology, Physics 2022; 113(2): 426-436.
Abstract: Tumor and target volume manual delineation remains a challenging task in head-and-neck cancer radiotherapy. The purpose of this study was to conduct a multi-institutional evaluation of manual delineations of gross tumor volume (GTV), high-risk clinical target volume (CTV), parotids, and submandibular glands on treatment simulation MR scans of oropharyngeal cancer (OPC) patients. Pre-treatment T1-weighted (T1w), T1-weighted with gadolinium contrast (T1w+C) and T2-weighted (T2w) MRI scans were retrospectively collected for 4 OPC patients under an IRB-approved protocol. The scans were provided to twenty-six radiation oncologists from seven international cancer centers who participated in this delineation study. In addition, patients' clinical history and physical examination findings, along with a medical photographic image and radiological results, were provided. The contours were compared using overlap/distance metrics using both STAPLE and pair-wise comparisons. Lastly, participants completed a brief questionnaire to assess participants' experience and CTV delineation institutional practices. Large variability was measured between observers' delineations for GTVs and CTVs. The mean Dice Similarity Coefficient values across all physicians' delineations for GTVp, GTVn, CTVp, and CTVn were 0.77, 0.67, 0.77, and 0.69, respectively, for STAPLE comparison and 0.67, 0.60, 0.67, and 0.58, respectively, for pair-wise analysis. Normal tissue contours were defined more consistently when considering overlap/distance metrics. The median radiation oncology clinical experience was 7 years. The median experience delineating on MRI was 3.5 years. The GTV-to-CTV margin used was 10 mm for six of seven participant institutions. One institution used 8 mm and three participants (from three different institutions) used a margin of 5 mm. The data from this study suggests that appropriate guidelines, contouring quality assurance sessions, and training are still needed for the adoption of MR-based treatment planning for head-and-neck cancers. Such efforts should play a critical role in reducing delineation variation and ensure standardization of target design across clinical practices.
DOI: 10.1016/j.ijrobp.2022.01.050
ORCID: 0000-0003-1721-0680
Journal: International Journal of Radiation Oncology, Biology, Physics
PubMed URL: 35124134
PubMed URL:
Type: Journal Article
Appears in Collections:Journal articles

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