PURPOSE: Peritumoral edema may harbor sarcoma cells. The extent of suspicious edema (SE) included in the treatment volume is subject to clinical judgment, balancing the risk of missing tumor cells with excess toxicity. Our goal was to determine variability in SE delineation by sarcoma radiation oncologists (RO). METHODS AND MATERIALS: Twelve expert ROs were provided with T1 gadolinium and T2-weighted MR images of 10 patients with high-grade extremity soft-tissue sarcoma. Gross tumor volume, clinical target volume (CTV)3cm (3 cm longitudinal and 1.5 cm radial margin), and CTV2cm (2 cm longitudinal and 1 cm radial margin) were contoured by a single observer. Suspicious peritumoral edema, defined as abnormal signal on T2 images, was independently delineated by all 12 ROs. Contouring agreement was analyzed using the simultaneous truth and performance level estimation (STAPLE) algorithm and kappa statistics. RESULTS: The mean volumes of GTV, CTV2cm, and CTV3cm were, respectively, 130 cm(3) (7-413 cm(3)), 280 cm(3) and 360 cm(3). The mean consensus volume computed using the STAPLE algorithm at 95% confidence interval was 188 cm(3) (24-565 cm(3)) with a substantial overall agreement corrected for chance (mean kappa = 0.71; range: 0.32-0.87). The minimum, maximum, and mean volume of SE (excluding the GTV) were 4, 182, and 58 cm(3) (representing a median of 29% of the GTV volume). The median volume of SE not included in the CTV2cm and in the CTV3cm was 5 and 0.3 cm(3), respectively. There were 3 large tumors with >30 cm(3) of SE not included in the CTV3cm volume. CONCLUSION: Despite the fact that SE would empirically seem to be a more subjective volume, a substantial or near-perfect interobserver agreement was observed in SE delineation in most cases with high-grade soft-tissue sarcomas of the extremity. A median of 97% of the consensus SE is within the CTV2cm (99.8% within the CTV3cm). In a minority of cases, however, significant expansion of the CTVs is required to cover SE.
PURPOSE: Peritumoral edema may harbor sarcoma cells. The extent of suspicious edema (SE) included in the treatment volume is subject to clinical judgment, balancing the risk of missing tumor cells with excess toxicity. Our goal was to determine variability in SE delineation by sarcoma radiation oncologists (RO). METHODS AND MATERIALS: Twelve expert ROs were provided with T1 gadolinium and T2-weighted MR images of 10 patients with high-grade extremity soft-tissue sarcoma. Gross tumor volume, clinical target volume (CTV)3cm (3 cm longitudinal and 1.5 cm radial margin), and CTV2cm (2 cm longitudinal and 1 cm radial margin) were contoured by a single observer. Suspicious peritumoral edema, defined as abnormal signal on T2 images, was independently delineated by all 12 ROs. Contouring agreement was analyzed using the simultaneous truth and performance level estimation (STAPLE) algorithm and kappa statistics. RESULTS: The mean volumes of GTV, CTV2cm, and CTV3cm were, respectively, 130 cm(3) (7-413 cm(3)), 280 cm(3) and 360 cm(3). The mean consensus volume computed using the STAPLE algorithm at 95% confidence interval was 188 cm(3) (24-565 cm(3)) with a substantial overall agreement corrected for chance (mean kappa = 0.71; range: 0.32-0.87). The minimum, maximum, and mean volume of SE (excluding the GTV) were 4, 182, and 58 cm(3) (representing a median of 29% of the GTV volume). The median volume of SE not included in the CTV2cm and in the CTV3cm was 5 and 0.3 cm(3), respectively. There were 3 large tumors with >30 cm(3) of SE not included in the CTV3cm volume. CONCLUSION: Despite the fact that SE would empirically seem to be a more subjective volume, a substantial or near-perfect interobserver agreement was observed in SE delineation in most cases with high-grade soft-tissue sarcomas of the extremity. A median of 97% of the consensus SE is within the CTV2cm (99.8% within the CTV3cm). In a minority of cases, however, significant expansion of the CTVs is required to cover SE.
Authors: Dian Wang; Walter Bosch; David G Kirsch; Rawan Al Lozi; Issam El Naqa; David Roberge; Steven E Finkelstein; Ivy Petersen; Michael Haddock; Yen-Lin E Chen; Naoyuki G Saito; Ying J Hitchcock; Aaron H Wolfson; Thomas F DeLaney Journal: Int J Radiat Oncol Biol Phys Date: 2011-01-27 Impact factor: 7.038
Authors: Lawrence M White; Jay S Wunder; Robert S Bell; Brian O'Sullivan; Charles Catton; Peter Ferguson; Martin Blackstein; Rita A Kandel Journal: Int J Radiat Oncol Biol Phys Date: 2005-04-01 Impact factor: 7.038
Authors: A M Davis; B O'Sullivan; R S Bell; R Turcotte; C N Catton; J S Wunder; P Chabot; A Hammond; V Benk; M Isler; C Freeman; K Goddard; A Bezjak; R A Kandel; A Sadura; A Day; K James; D Tu; J Pater; B Zee Journal: J Clin Oncol Date: 2002-11-15 Impact factor: 44.544
Authors: Aileen M Davis; Brian O'Sullivan; Robert Turcotte; Robert Bell; Charles Catton; Pierre Chabot; Jay Wunder; Alex Hammond; Veronique Benk; Rita Kandel; Karen Goddard; Carolyn Freeman; Anna Sadura; Benny Zee; Andrew Day; Dongsheng Tu; Joseph Pater Journal: Radiother Oncol Date: 2005-04 Impact factor: 6.280
Authors: A D Baheti; S H Tirumani; R Sewatkar; A B Shinagare; J L Hornick; N H Ramaiya; J P Jagannathan Journal: Br J Radiol Date: 2014-11-28 Impact factor: 3.039
Authors: Elizabeth H Baldini; Ross A Abrams; Walter Bosch; David Roberge; Rick L M Haas; Charles N Catton; Daniel J Indelicato; Jeffrey R Olsen; Curtiland Deville; Yen-Lin Chen; Steven E Finkelstein; Thomas F DeLaney; Dian Wang Journal: Int J Radiat Oncol Biol Phys Date: 2015-05-01 Impact factor: 7.038
Authors: Xiaomeng Zhang; Yen-Lin E Chen; Ruth Lim; Chuan Huang; Ivan A Chebib; Georges El Fakhri Journal: Magn Reson Imaging Date: 2015-10-31 Impact factor: 2.546
Authors: R Correa; J Gómez-Millán; M Lobato; A Fernández; R Ordoñez; C Castro; Y Lupiañez; J A Medina Journal: Clin Transl Oncol Date: 2018-02-23 Impact factor: 3.405
Authors: Chan Woo Wee; Wonmo Sung; Hyun-Cheol Kang; Kwan Ho Cho; Tae Jin Han; Bae-Kwon Jeong; Jae-Uk Jeong; Haeyoung Kim; In Ah Kim; Jin Hee Kim; Sung Hwan Kim; Suzy Kim; Dong Soo Lee; Me Yeon Lee; Do Hoon Lim; Hye Li Park; Chang-Ok Suh; Sang Min Yoon; Il Han Kim Journal: Radiat Oncol Date: 2015-07-02 Impact factor: 3.481
Authors: Cameron M Callaghan; M M Hasibuzzaman; Samuel N Rodman; Jessica E Goetz; Kranti A Mapuskar; Michael S Petronek; Emily J Steinbach; Benjamin J Miller; Casey F Pulliam; Mitchell C Coleman; Varun V Monga; Mohammed M Milhem; Douglas R Spitz; Bryan G Allen Journal: Cancers (Basel) Date: 2020-08-12 Impact factor: 6.639