Elizabeth H Baldini1, Ross A Abrams2, Walter Bosch3, David Roberge4, Rick L M Haas5, Charles N Catton6, Daniel J Indelicato7, Jeffrey R Olsen3, Curtiland Deville8, Yen-Lin Chen9, Steven E Finkelstein10, Thomas F DeLaney9, Dian Wang2. 1. Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: ebaldini@partners.org. 2. Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois. 3. Department of Radiation Oncology, Washington University, St. Louis, Missouri. 4. Department of Radiation Oncology, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada. 5. Department of Radiotherapy, Netherlands Cancer Institute, Amsterdam, The Netherlands. 6. Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada. 7. Department of Radiation Oncology, University of Florida Medical Center, Jacksonville, Florida. 8. Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania. 9. Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts. 10. Translational Research Consortium, 21st Century Oncology, Scottsdale, Arizona.
Abstract
PURPOSE: The purpose of this study was to evaluate the variability in target volume and organ at risk (OAR) contour delineation for retroperitoneal sarcoma (RPS) among 12 sarcoma radiation oncologists. METHODS AND MATERIALS: Radiation planning computed tomography (CT) scans for 2 cases of RPS were distributed among 12 sarcoma radiation oncologists with instructions for contouring gross tumor volume (GTV), clinical target volume (CTV), high-risk CTV (HR CTV: area judged to be at high risk of resulting in positive margins after resection), and OARs: bowel bag, small bowel, colon, stomach, and duodenum. Analysis of contour agreement was performed using the simultaneous truth and performance level estimation (STAPLE) algorithm and kappa statistics. RESULTS: Ten radiation oncologists contoured both RPS cases, 1 contoured only RPS1, and 1 contoured only RPS2 such that each case was contoured by 11 radiation oncologists. The first case (RPS 1) was a patient with a de-differentiated (DD) liposarcoma (LPS) with a predominant well-differentiated (WD) component, and the second case (RPS 2) was a patient with DD LPS made up almost entirely of a DD component. Contouring agreement for GTV and CTV contours was high. However, the agreement for HR CTVs was only moderate. For OARs, agreement for stomach, bowel bag, small bowel, and colon was high, but agreement for duodenum (distorted by tumor in one of these cases) was fair to moderate. CONCLUSIONS: For preoperative treatment of RPS, sarcoma radiation oncologists contoured GTV, CTV, and most OARs with a high level of agreement. HR CTV contours were more variable. Further clarification of this volume with the help of sarcoma surgical oncologists is necessary to reach consensus. More attention to delineation of the duodenum is also needed.
PURPOSE: The purpose of this study was to evaluate the variability in target volume and organ at risk (OAR) contour delineation for retroperitoneal sarcoma (RPS) among 12 sarcoma radiation oncologists. METHODS AND MATERIALS: Radiation planning computed tomography (CT) scans for 2 cases of RPS were distributed among 12 sarcoma radiation oncologists with instructions for contouring gross tumor volume (GTV), clinical target volume (CTV), high-risk CTV (HR CTV: area judged to be at high risk of resulting in positive margins after resection), and OARs: bowel bag, small bowel, colon, stomach, and duodenum. Analysis of contour agreement was performed using the simultaneous truth and performance level estimation (STAPLE) algorithm and kappa statistics. RESULTS: Ten radiation oncologists contoured both RPS cases, 1 contoured only RPS1, and 1 contoured only RPS2 such that each case was contoured by 11 radiation oncologists. The first case (RPS 1) was a patient with a de-differentiated (DD) liposarcoma (LPS) with a predominant well-differentiated (WD) component, and the second case (RPS 2) was a patient with DD LPS made up almost entirely of a DD component. Contouring agreement for GTV and CTV contours was high. However, the agreement for HR CTVs was only moderate. For OARs, agreement for stomach, bowel bag, small bowel, and colon was high, but agreement for duodenum (distorted by tumor in one of these cases) was fair to moderate. CONCLUSIONS: For preoperative treatment of RPS, sarcoma radiation oncologists contoured GTV, CTV, and most OARs with a high level of agreement. HR CTV contours were more variable. Further clarification of this volume with the help of sarcoma surgical oncologists is necessary to reach consensus. More attention to delineation of the duodenum is also needed.
Authors: Elizabeth H Baldini; Dian Wang; Rick L M Haas; Charles N Catton; Daniel J Indelicato; David G Kirsch; David Roberge; Kilian Salerno; Curtiland Deville; B Ashleigh Guadagnolo; Brian O'Sullivan; Ivy A Petersen; Cecile Le Pechoux; Ross A Abrams; Thomas F DeLaney Journal: Int J Radiat Oncol Biol Phys Date: 2015-07-01 Impact factor: 7.038
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