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Inter-observer variability in target delineation increases during adaptive treatment of head-and-neck and lung cancer.
- Source :
-
Acta oncologica (Stockholm, Sweden) [Acta Oncol] 2019 Oct; Vol. 58 (10), pp. 1378-1385. Date of Electronic Publication: 2019 Jul 04. - Publication Year :
- 2019
-
Abstract
- Introduction: Inter-observer variability (IOV) in target volume delineation is a well-documented source of geometric uncertainty in radiotherapy. Such variability has not yet been explored in the context of adaptive re-delineation based on imaging data acquired during treatment. We compared IOV in the pre- and mid-treatment setting using expert primary gross tumour volume (GTV) and clinical target volume (CTV) delineations in locoregionally advanced head-and-neck squamous cell carcinoma (HNSCC) and (non-)small cell lung cancer [(N)SCLC]. Material and methods: Five and six observers participated in the HNSCC and (N)SCLC arm, respectively, and provided delineations for five cases each. Imaging data consisted of CT studies partly complemented by FDG-PET and was provided in two separate phases for pre- and mid-treatment. Global delineation compatibility was assessed with a volume overlap metric (the Generalised Conformity Index), while local extremes of IOV were identified through the standard deviation of surface distances from observer delineations to a median consensus delineation. Details of delineation procedures, in particular, GTV to CTV expansion and adaptation strategies, were collected through a questionnaire. Results: Volume overlap analysis revealed a worsening of IOV in all but one case per disease site, which failed to reach significance in this small sample ( p -value range .063-.125). Changes in agreement were propagated from GTV to CTV delineations, but correlation could not be formally demonstrated. Surface distance based analysis identified longitudinal target extent as a pervasive source of disagreement for HNSCC. High variability in (N)SCLC was often associated with tumours abutting consolidated lung tissue or potentially invading the mediastinum. Adaptation practices were variable between observers with fewer than half stating that they consistently adapted pre-treatment delineations during treatment. Conclusion: IOV in target volume delineation increases during treatment, where a disparity in institutional adaptation practices adds to the conventional causes of IOV. Consensus guidelines are urgently needed.
- Subjects :
- Carcinoma, Non-Small-Cell Lung diagnostic imaging
Carcinoma, Non-Small-Cell Lung pathology
Dose Fractionation, Radiation
Head and Neck Neoplasms diagnostic imaging
Head and Neck Neoplasms pathology
Humans
Lung Neoplasms diagnostic imaging
Lung Neoplasms pathology
Observer Variation
Positron-Emission Tomography
Radiotherapy Planning, Computer-Assisted methods
Small Cell Lung Carcinoma diagnostic imaging
Small Cell Lung Carcinoma pathology
Squamous Cell Carcinoma of Head and Neck diagnostic imaging
Squamous Cell Carcinoma of Head and Neck pathology
Tomography, X-Ray Computed
Treatment Outcome
Tumor Burden radiation effects
Carcinoma, Non-Small-Cell Lung radiotherapy
Head and Neck Neoplasms radiotherapy
Lung Neoplasms radiotherapy
Radiotherapy Planning, Computer-Assisted statistics & numerical data
Small Cell Lung Carcinoma radiotherapy
Squamous Cell Carcinoma of Head and Neck radiotherapy
Subjects
Details
- Language :
- English
- ISSN :
- 1651-226X
- Volume :
- 58
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Acta oncologica (Stockholm, Sweden)
- Publication Type :
- Academic Journal
- Accession number :
- 31271079
- Full Text :
- https://doi.org/10.1080/0284186X.2019.1629017