Expert Consensus Contouring Guidelines for Intensity Modulated Radiation Therapy in Esophageal and Gastroesophageal Junction Cancer

Journal Article · Wed Jul 15 04:00:00 EDT 2015 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2015.03.030· OSTI ID:22462387

Bosch, Walter R. ^[1]; Chang, Daniel T. ^[2]; Hong, Theodore S. ^[3]; Jabbour, Salma K. ^[4]; Kleinberg, Lawrence R. ^[5]; Mamon, Harvey J. ^[6]; Thomas, Charles R. ^[7]; Goodman, Karyn A. ^[8]

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1. Washington University, St. Louis, Missouri (United States)
2. Stanford Cancer Institute, Stanford, California (United States)
3. Massachusetts General Hospital, Boston, Massachusetts (United States)
4. Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey (United States)
5. Johns Hopkins Medical Center, Baltimore, Maryland (United States)
6. Brigham and Women's Hospital, Boston, Massachusetts (United States)
7. Knight Cancer Institute, Oregon Health & Sciences University, Portland, Oregon (United States)
8. Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

Purpose/Objective(s): Current guidelines for esophageal cancer contouring are derived from traditional 2-dimensional fields based on bony landmarks, and they do not provide sufficient anatomic detail to ensure consistent contouring for more conformal radiation therapy techniques such as intensity modulated radiation therapy (IMRT). Therefore, we convened an expert panel with the specific aim to derive contouring guidelines and generate an atlas for the clinical target volume (CTV) in esophageal or gastroesophageal junction (GEJ) cancer. Methods and Materials: Eight expert academically based gastrointestinal radiation oncologists participated. Three sample cases were chosen: a GEJ cancer, a distal esophageal cancer, and a mid-upper esophageal cancer. Uniform computed tomographic (CT) simulation datasets and accompanying diagnostic positron emission tomographic/CT images were distributed to each expert, and the expert was instructed to generate gross tumor volume (GTV) and CTV contours for each case. All contours were aggregated and subjected to quantitative analysis to assess the degree of concordance between experts and to generate draft consensus contours. The panel then refined these contours to generate the contouring atlas. Results: The κ statistics indicated substantial agreement between panelists for each of the 3 test cases. A consensus CTV atlas was generated for the 3 test cases, each representing common anatomic presentations of esophageal cancer. The panel agreed on guidelines and principles to facilitate the generalizability of the atlas to individual cases. Conclusions: This expert panel successfully reached agreement on contouring guidelines for esophageal and GEJ IMRT and generated a reference CTV atlas. This atlas will serve as a reference for IMRT contours for clinical practice and prospective trial design. Subsequent patterns of failure analyses of clinical datasets using these guidelines may require modification in the future.

• OSTI ID: 22462387
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 4 Vol. 92; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

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