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Title: Comprehensive Quantitative Evaluation of Variability in Magnetic Resonance-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
Affiliation: Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama..
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas..
Department of Radiation Oncology, Klinikum Kassel, Kassel, Germany..
Department of Radiation Therapy, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands..
Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands..
Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada..
Department of Clinical Oncology, Christie NHS Foundation Trust, Manchester, United Kingdom..
Department of Radiation Oncology, University of Arizona, Tucson, Arizona..
Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom..
Olivia Newton-John Cancer Wellness and Research Centre
Radiation Oncology
Issue Date: 1-Jun-2022
Date: 2022
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 radiation therapy. 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 magnetic resonance scans of patients with oropharyngeal cancer. We retrospectively collected pretreatment T1-weighted, T1-weighted with gadolinium contrast, and T2-weighted magnetic resonance imaging scans for 4 patients with oropharyngeal cancer under an institution review board-approved protocol. We provided the scans to 26 radiation oncologists from 7 international cancer centers that participated in this delineation study. We also provide the patients' clinical history and physical examination findings, along with a medical photographic image and radiologic results. We used both the Simultaneous Truth and Performance Level Estimation algorithm and pair-wise comparisons of the contours, using overlap/distance metrics. Lastly, to assess experience and CTV delineation institutional practices, we had participants complete a brief questionnaire. 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 Simultaneous Truth and Performance Level Estimation algorithm 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 magnetic resonance imaging was 3.5 years. The GTV-to-CTV margin used was 10 mm for 6 of 7 participant institutions. One institution used 8 mm, and 3 participants (from 3 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 magnetic resonance-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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