Joeri Mul1,2, Patrick Melchior3, Enrica Seravalli2, Daniel Saunders4, Stephanie Bolle5, Alison L Cameron6, Kristin Gurtner7, Semi Harrabi8, Yasmin Lassen-Ramshad9, Naomi Lavan10, Henriette Magelssen11, Henry Mandeville12, Tom Boterberg13, Petra S Kroon2, Alexis N T J Kotte2, Bianca A W Hoeben1,2, Peter S N van Rossum2, Martine van Grotel1, Norbert Graf14, Marry M van den Heuvel-Eibrink1, Christian Rübe3, Geert O Janssens1,2. 1. Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands. 2. Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands. 3. Dept. of Radiation Oncology, Saarland University Hospital, Homburg, Germany. 4. Dept. of Clinical Oncology, The Christie Hospital, Manchester, United Kingdom. 5. Dept. of Radiation Oncology, Gustave Roussy, Villejuif, France. 6. Bristol Cancer Institute, University Hospitals, Bristol, United Kingdom. 7. Dept. of Radiation Oncology, University Hospital Carl Gustav Carus, Dresden, Germany. 8. Dept. of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany. 9. Dept. of Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark. 10. St. Luke's Radiation Oncology Network, Dublin, Ireland. 11. Dept. of Oncology, Oslo University Hospital, Oslo, Norway. 12. Dept. of Clinical Oncology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom. 13. Dept. of Radiation Oncology, Ghent University Hospital, Ghent, Belgium. 14. Dept. of Pediatric Oncology, Saarland University Hospital, Homburg, Germany.
Abstract
BACKGROUND AND PURPOSE: Recently, the SIOP-RTSG developed a highly-conformal flank target volume definition for children with renal tumors. The aims of this study were to evaluate the inter-clinician delineation variation of this new target volume definition in an international multicenter setting and to explore the necessity of quality assurance. MATERIALS AND METHODS: Six pediatric renal cancer cases were transferred to ten radiation oncologists from seven European countries ('participants'). These participants delineated the pre- and postoperative Gross Tumor Volume (GTVpre/post), and Clinical Target Volume (CTV) during two test phases (case 1-2 and 3-4), followed by guideline refinement and a quality assurance phase (case 5-6). Reference target volumes (TVref) were established by three experienced radiation oncologists. The Dice Similarity Coefficient between the reference and participants (DSCref/part) was calculated per case. Delineations of case 5-6 were graded by four independent reviewers as 'per protocol' (0-4 mm), 'minor deviation' (5-9 mm) or 'major deviation' (≥10 mm) from the delineation guideline using 18 standardized criteria. Also, a major deviation resulting in underestimation of the CTVref was regarded as an unacceptable variation. RESULTS: A total of 57/60 delineation sets were completed. The median DSCref/part for the CTV was 0.55 without improvement after sequential cases (case 3-4 vs. case 5-6: p = 0.15). For case 5-6, a major deviation was found for 5/18, 12/17, 18/18 and 4/9 collected delineations of the GTVpre, GTVpost, CTV-T and CTV-N, respectively. An unacceptable variation from the CTVref was found for 7/9 participants for case 5 and 6/9 participants for case 6. CONCLUSION: This international multicenter delineation exercise demonstrates that the new consensus for highly-conformal postoperative flank target volume delineation leads to geometrical variation among participants. Moreover, standardized review showed an unacceptable delineation variation in the majority of the participants. These findings strongly suggest the need for additional training and centralized pre-treatment review when this target volume delineation approach is implemented on a larger scale.
BACKGROUND AND PURPOSE: Recently, the SIOP-RTSG developed a highly-conformal flank target volume definition for children with renal tumors. The aims of this study were to evaluate the inter-clinician delineation variation of this new target volume definition in an international multicenter setting and to explore the necessity of quality assurance. MATERIALS AND METHODS: Six pediatric renal cancer cases were transferred to ten radiation oncologists from seven European countries ('participants'). These participants delineated the pre- and postoperative Gross Tumor Volume (GTVpre/post), and Clinical Target Volume (CTV) during two test phases (case 1-2 and 3-4), followed by guideline refinement and a quality assurance phase (case 5-6). Reference target volumes (TVref) were established by three experienced radiation oncologists. The Dice Similarity Coefficient between the reference and participants (DSCref/part) was calculated per case. Delineations of case 5-6 were graded by four independent reviewers as 'per protocol' (0-4 mm), 'minor deviation' (5-9 mm) or 'major deviation' (≥10 mm) from the delineation guideline using 18 standardized criteria. Also, a major deviation resulting in underestimation of the CTVref was regarded as an unacceptable variation. RESULTS: A total of 57/60 delineation sets were completed. The median DSCref/part for the CTV was 0.55 without improvement after sequential cases (case 3-4 vs. case 5-6: p = 0.15). For case 5-6, a major deviation was found for 5/18, 12/17, 18/18 and 4/9 collected delineations of the GTVpre, GTVpost, CTV-T and CTV-N, respectively. An unacceptable variation from the CTVref was found for 7/9 participants for case 5 and 6/9 participants for case 6. CONCLUSION: This international multicenter delineation exercise demonstrates that the new consensus for highly-conformal postoperative flank target volume delineation leads to geometrical variation among participants. Moreover, standardized review showed an unacceptable delineation variation in the majority of the participants. These findings strongly suggest the need for additional training and centralized pre-treatment review when this target volume delineation approach is implemented on a larger scale.
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