Panayiotis Mavroidis1, Drosoula Giantsoudis2, Musaddiq J Awan3, Jasper Nijkamp4, Coen R N Rasch5, Joop C Duppen4, Charles R Thomas6, Paul Okunieff7, William E Jones8, Lisa A Kachnic9, Niko Papanikolaou10, Clifton D Fuller3. 1. Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, USA; Department of Oncology-Pathology, Karolinska Institutet and Stockholm University, Sweden. Electronic address: mavroidis@uthscsa.edu. 2. Department of Radiation Oncology, Massachusetts General Hospital Cancer Center, Boston, USA. 3. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. 4. Department of Radiotherapy, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Huis, Amsterdam, The Netherlands. 5. Department of Radiotherapy, Academic Medical Center, Amsterdam, The Netherlands. 6. Department of Radiation Medicine, Oregon Health & Science University, Portland, USA. 7. Department of Radiation Oncology, University of Florida, Gainesville, USA. 8. Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, USA; Department of Radiation Oncology, Audie L. Murphy Veterans Administration Hospital, San Antonio, USA. 9. Department of Radiation Oncology, Massachusetts General Hospital Cancer Center, Boston, USA; Department of Radiation Oncology, Boston University Medical Center, USA. 10. Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, USA.
Abstract
PURPOSE: The aim of this study is to ascertain the subsequent radiobiological impact of using a consensus guideline target volume delineation atlas. MATERIALS AND METHODS: Using a representative case and target volume delineation instructions derived from a proposed IMRT rectal cancer clinical trial, gross tumor volume (GTV) and clinical/planning target volumes (CTV/PTV) were contoured by 13 physician observers (Phase 1). The observers were then randomly assigned to follow (atlas) or not-follow (control) a consensus guideline/atlas for anorectal cancers, and instructed to re-contour the same case (Phase 2). RESULTS: The atlas group was found to have increased tumor control probability (TCP) after the atlas intervention for both the CTV (p<0.0001) and PTV1 (p=0.0011) with decreasing normal tissue complication probability (NTCP) for small intestine, while the control group did not. Additionally, the atlas group had reduced variance in TCP for all target volumes and reduced variance in NTCP for the bowel. In Phase 2, the atlas group had increased TCP relative to the control for CTV (p=0.03). CONCLUSIONS: Visual atlas and consensus treatment guideline usage in the development of rectal cancer IMRT treatment plans reduced the inter-observer radiobiological variation, with clinically relevant TCP alteration for CTV and PTV volumes.
RCT Entities:
PURPOSE: The aim of this study is to ascertain the subsequent radiobiological impact of using a consensus guideline target volume delineation atlas. MATERIALS AND METHODS: Using a representative case and target volume delineation instructions derived from a proposed IMRT rectal cancer clinical trial, gross tumor volume (GTV) and clinical/planning target volumes (CTV/PTV) were contoured by 13 physician observers (Phase 1). The observers were then randomly assigned to follow (atlas) or not-follow (control) a consensus guideline/atlas for anorectal cancers, and instructed to re-contour the same case (Phase 2). RESULTS: The atlas group was found to have increased tumor control probability (TCP) after the atlas intervention for both the CTV (p<0.0001) and PTV1 (p=0.0011) with decreasing normal tissue complication probability (NTCP) for small intestine, while the control group did not. Additionally, the atlas group had reduced variance in TCP for all target volumes and reduced variance in NTCP for the bowel. In Phase 2, the atlas group had increased TCP relative to the control for CTV (p=0.03). CONCLUSIONS:Visual atlas and consensus treatment guideline usage in the development of rectal cancer IMRT treatment plans reduced the inter-observer radiobiological variation, with clinically relevant TCP alteration for CTV and PTV volumes.
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