Maria Cristina Leonardi1, Matteo Pepa1, Simone Giovanni Gugliandolo1, Rosa Luraschi2, Sabrina Vigorito2, Damaris Patricia Rojas1, Maria Rosa La Porta3, Domenico Cante3, Edoardo Petrucci4, Lorenza Marino5, Giuseppina Borzì6, Edy Ippolito7, Maristella Marrocco8, Alessandra Huscher9, Matteo Chieregato10, Angela Argenone11, Luciano Iadanza12, Fiorenza De Rose13, Francesca Lobefalo13, Francesca Cucciarelli14, Marco Valenti15, Maria Carmen De Santis16, Anna Cavallo17, Francesca Rossi18, Serenella Russo19, Agnese Prisco20, Marika Guernieri21, Roberta Guarnaccia22, Tiziana Malatesta23, Ilaria Meaglia24, Marco Liotta25, Paola Tabarelli de Fatis25, Isabella Palumbo26, Marta Marcantonini27, Sarah Pia Colangione28, Emilio Mezzenga29, Sara Falivene30, Maria Mormile31, Vincenzo Ravo32, Cecilia Arrichiello32, Alessandra Fozza33, Maria Paola Barbero34, Giovanni Battista Ivaldi24, Gianpiero Catalano35, Cristiana Vidali36, Cynthia Aristei26, Caterina Giannitto37, Eleonora Miglietta1, Antonella Ciabattoni38, Icro Meattini39,40, Roberto Orecchia41, Federica Cattani2, Barbara Alicja Jereczek-Fossa1,42. 1. Division of Radiation Oncology, IEO Istituto Europeo di Oncologia IRCCS, Milano, Italy. 2. Unit of Medical Physics, IEO Istituto Europeo di Oncologia IRCCS, Milano, Italy. 3. Radiotherapy Department, ASL TO4 Ivrea Community Hospital, Ivrea, Italy. 4. Unit of Medical Physics, ASL TO4 Ivrea Community Hospital, Ivrea, Italy. 5. Radiotherapy Unit, REM Radioterapia, Viagrande (CT), Italy. 6. Unit of Medical Physics, REM Radioterapia, Viagrande (CT), Italy. 7. Department of Radiotherapy, Campus Bio-Medico University, Roma, Italy. 8. Unit of Medical Physics, Campus Bio-Medico University, Roma, Italy. 9. Radiotherapy Unit, Fondazione Poliambulanza, Brescia, Italy. 10. Unit of Medical Physics, Fondazione Poliambulanza, Brescia, Italy. 11. Division of Radiation Oncology, Azienda Ospedaliera di Rilievo Nazionale San Pio, Benevento, Italy. 12. Unit of Medical Physics, Azienda Ospedaliera di Rilievo Nazionale San Pio, Benevento, italy. 13. Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Centre IRCCS, Milano, Italy. 14. Department of Internal Medicine, Radiotherapy Institute, Ospedali Riuniti Umberto I, G.M. Lancisi, G. Salesi, Ancona, Italy. 15. Unit of Medical Physics, Ospedali Riuniti Umberto I, G.M. Lancisi, G. Salesi, Ancona, Italy. 16. Radiotherapy Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy. 17. Unit of Medical Physics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy. 18. Radiotherapy Unit, Usl Toscana Centro, Ospedale Santa Maria Annunziata, Firenze, Italy. 19. Unit of Medical Physics, Usl Toscana Centro, Ospedale Santa Maria Annunziata, Firenze, Italy. 20. Department of Radiotherapy, ASUFC - P.O. " Santa Maria della Misericordia" di Udine, Udine, Italy. 21. Unit of Medical Physics, ASUFC - P.O. " Santa Maria della Misericordia" di Udine, Udine, Italy. 22. Radiotherapy Unit, Ospedale Fatebenefratelli Isola Tiberina, Roma, Italy. 23. Unit of Medical Physics, Ospedale Fatebenefratelli Isola Tiberina, Roma, Italy. 24. Radiation Oncology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy. 25. Medical Physics Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy. 26. Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy. 27. Medical Physics Unit, Perugia General Hospital, Perugia, Italy. 28. Radiotherapy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy. 29. Medical Physics Unit, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) "Dino Amadori", Meldola (FC), Italy. 30. Department of Radiotherapy, ASL Napoli 1 Centro - Ospedale del Mare, Napoli, Italy. 31. Unit of Medical Physics, ASL Napoli 1 Centro - Ospedale del Mare, Napoli, Italy. 32. Unit of Radiotherapy, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italy. 33. Division of Radiation Oncology, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. 34. Unit of Medical Physics, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. 35. Department of Radiotherapy, IRCCS MultiMedica, Sesto San Giovanni (MI), Italy. 36. Department of Radiation Oncology, Azienda Sanitaria Universitaria Integrata di Trieste (ASUI-TS), Trieste, Italy. 37. Division of Radiology, IEO Istituto Europeo di Oncologia IRCCS, Milano, Italy. 38. Department of Radiotherapy, San Filippo Neri Hospital, ASL Roma 1, Roma, Italy. 39. Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy. 40. Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Firenze, Italy. 41. Scientific Direction, IEO Istituto Europeo di Oncologia IRCCS, Milano, Italy. 42. Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy.
Abstract
OBJECTIVES: To determine interobserver variability in axillary nodal contouring in breast cancer (BC) radiotherapy (RT) by comparing the clinical target volume of participating single centres (SC-CTV) with a gold-standard CTV (GS-CTV). METHODS: The GS-CTV of three patients (P1, P2, P3) with increasing complexity was created in DICOM format from the median contour of axillary CTVs drawn by BC experts, validated using the simultaneous truth and performance-level estimation and peer-reviewed. GS-CTVs were compared with the correspondent SC-CTVs drawn by radiation oncologists, using validated metrics and a total score (TS) integrating all of them. RESULTS: Eighteen RT centres participated in the study. Comparative analyses revealed that, on average, the SC-CTVs were smaller than GS-CTV for P1 and P2 (by -29.25% and -27.83%, respectively) and larger for P3 (by +12.53%). The mean Jaccard index was greater for P1 and P2 compared to P3, but the overlap extent value was around 0.50 or less. Regarding nodal levels, L4 showed the highest concordance with the GS. In the intra-patient comparison, L2 and L3 achieved lower TS than L4. Nodal levels showed discrepancy with GS, which was not statistically significant for P1, and negligible for P2, while P3 had the worst agreement. DICE similarity coefficient did not exceed the minimum threshold for agreement of 0.70 in all the measurements. CONCLUSIONS: Substantial differences were observed between SC- and GS-CTV, especially for P3 with altered arm setup. L2 and L3 were the most critical levels. The study highlighted these key points to address. ADVANCES IN KNOWLEDGE: The present study compares, by means of validated geometric indexes, manual segmentations of axillary lymph nodes in breast cancer from different observers and different institutions made on radiotherapy planning CT images. Assessing such variability is of paramount importance, as geometric uncertainties might lead to incorrect dosimetry and compromise oncological outcome.
OBJECTIVES: To determine interobserver variability in axillary nodal contouring in breast cancer (BC) radiotherapy (RT) by comparing the clinical target volume of participating single centres (SC-CTV) with a gold-standard CTV (GS-CTV). METHODS: The GS-CTV of three patients (P1, P2, P3) with increasing complexity was created in DICOM format from the median contour of axillary CTVs drawn by BC experts, validated using the simultaneous truth and performance-level estimation and peer-reviewed. GS-CTVs were compared with the correspondent SC-CTVs drawn by radiation oncologists, using validated metrics and a total score (TS) integrating all of them. RESULTS: Eighteen RT centres participated in the study. Comparative analyses revealed that, on average, the SC-CTVs were smaller than GS-CTV for P1 and P2 (by -29.25% and -27.83%, respectively) and larger for P3 (by +12.53%). The mean Jaccard index was greater for P1 and P2 compared to P3, but the overlap extent value was around 0.50 or less. Regarding nodal levels, L4 showed the highest concordance with the GS. In the intra-patient comparison, L2 and L3 achieved lower TS than L4. Nodal levels showed discrepancy with GS, which was not statistically significant for P1, and negligible for P2, while P3 had the worst agreement. DICE similarity coefficient did not exceed the minimum threshold for agreement of 0.70 in all the measurements. CONCLUSIONS: Substantial differences were observed between SC- and GS-CTV, especially for P3 with altered arm setup. L2 and L3 were the most critical levels. The study highlighted these key points to address. ADVANCES IN KNOWLEDGE: The present study compares, by means of validated geometric indexes, manual segmentations of axillary lymph nodes in breast cancer from different observers and different institutions made on radiotherapy planning CT images. Assessing such variability is of paramount importance, as geometric uncertainties might lead to incorrect dosimetry and compromise oncological outcome.
Authors: X Allen Li; An Tai; Douglas W Arthur; Thomas A Buchholz; Shannon Macdonald; Lawrence B Marks; Jean M Moran; Lori J Pierce; Rachel Rabinovitch; Alphonse Taghian; Frank Vicini; Wendy Woodward; Julia R White Journal: Int J Radiat Oncol Biol Phys Date: 2009-03-01 Impact factor: 7.038
Authors: Ross P Petersen; Pauline T Truong; Hosam A Kader; Eric Berthelet; Junella C Lee; Michelle L Hilts; Adam S Kader; Wayne A Beckham; Ivo A Olivotto Journal: Int J Radiat Oncol Biol Phys Date: 2007-09-01 Impact factor: 7.038