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Title: Comparison and Consensus Guidelines for Delineation of Clinical Target Volume for CT- and MR-Based Brachytherapy in Locally Advanced Cervical Cancer

Abstract

Objective: To create and compare consensus clinical target volume (CTV) contours for computed tomography (CT) and 3-Tesla (3-T) magnetic resonance (MR) image-based cervical-cancer brachytherapy. Methods and Materials: Twenty-three experts in gynecologic radiation oncology contoured the same 3 cervical cancer brachytherapy cases: 1 stage IIB near-complete response (CR) case with a tandem and ovoid, 1 stage IIB partial response (PR) case with tandem and ovoid with needles, and 1 stage IB2 CR case with a tandem and ring applicator. The CT contours were completed before the MRI contours. These were analyzed for consistency and clarity of target delineation using an expectation maximization algorithm for simultaneous truth and performance level estimation (STAPLE), with κ statistics as a measure of agreement between participants. The conformity index was calculated for each of the 6 data sets. Dice coefficients were generated to compare the CT and MR contours of the same case. Results: For all 3 cases, the mean tumor volume was smaller on MR than on CT (P<.001). The κ and conformity index estimates were slightly higher for CT, indicating a higher level of agreement on CT. The Dice coefficients were 89% for the stage IB2 case with a CR, 74% for the stagemore » IIB case with a PR, and 57% for the stage IIB case with a CR. Conclusion: In a comparison of MR-contoured with CT-contoured CTV volumes, the higher level of agreement on CT may be due to the more distinct contrast medium visible on the images at the time of brachytherapy. MR at the time of brachytherapy may be of greatest benefit in patients with large tumors with parametrial extension that have a partial or complete response to external beam. On the basis of these results, a 95% consensus volume was generated for CT and for MR. Online contouring atlases are available for instruction at (http://www.nrgoncology.org/Resources/ContouringAtlases/GYNCervicalBrachytherapy.aspx)« less

Authors:
 [1];  [2];  [3];  [4];  [5]; ;  [6];  [7];  [8];  [9];  [10];  [11];  [12];  [13];  [7];  [14];  [15];  [16];  [17];
  1. Medical College of Wisconsin, Milwaukee, Wisconsin (United States)
  2. University of Utah Huntsman Cancer Hospital, Salt Lake City, Utah (United States)
  3. University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States)
  4. University of Iowa, Iowa City, Iowa (United States)
  5. University of Alabama, Birmingham, Alabama (United States)
  6. London Health Sciences Centre and Western University, London, Ontario (Canada)
  7. Mayo Medical Center, Rochester, Minnesota (United States)
  8. University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
  9. University of North Carolina, Chapel Hill, North Carolina (United States)
  10. Case Western Reserve University, Cleveland, Ohio (United States)
  11. Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts (United States)
  12. University of Pennsylvania, Philadelphia, Pennsylvania (United States)
  13. University of Washington, Seattle, Washington (United States)
  14. Division of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana (Slovenia)
  15. University of Miami Miller School of Medicine, Miami, Florida (United States)
  16. Loyola University Strich School of Medicine, Chicago, Illinois (United States)
  17. The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois (United States)
Publication Date:
OSTI Identifier:
22423816
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 90; Journal Issue: 2; Other Information: Copyright (c) 2014 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ALGORITHMS; BRACHYTHERAPY; COMPARATIVE EVALUATIONS; COMPUTERIZED TOMOGRAPHY; CONTRAST MEDIA; NEOPLASMS; NMR IMAGING; PATIENTS; RECOMMENDATIONS

Citation Formats

Viswanathan, Akila N., E-mail: aviswanathan@lroc.harvard.edu, Erickson, Beth, Gaffney, David K., Beriwal, Sushil, Bhatia, Sudershan K., Lee Burnett, Omer, D'Souza, David P., Patil, Nikhilesh, Haddock, Michael G., Jhingran, Anuja, Jones, Ellen L., Kunos, Charles A., Lee, Larissa J., Lin, Lilie L., Mayr, Nina A., Petersen, Ivy, Petric, Primoz, Department of Radiation Oncology, National Center for Cancer Care and Research, Doha, Portelance, Lorraine, Small, William, Strauss, Jonathan B., and others, and. Comparison and Consensus Guidelines for Delineation of Clinical Target Volume for CT- and MR-Based Brachytherapy in Locally Advanced Cervical Cancer. United States: N. p., 2014. Web. doi:10.1016/J.IJROBP.2014.06.005.
Viswanathan, Akila N., E-mail: aviswanathan@lroc.harvard.edu, Erickson, Beth, Gaffney, David K., Beriwal, Sushil, Bhatia, Sudershan K., Lee Burnett, Omer, D'Souza, David P., Patil, Nikhilesh, Haddock, Michael G., Jhingran, Anuja, Jones, Ellen L., Kunos, Charles A., Lee, Larissa J., Lin, Lilie L., Mayr, Nina A., Petersen, Ivy, Petric, Primoz, Department of Radiation Oncology, National Center for Cancer Care and Research, Doha, Portelance, Lorraine, Small, William, Strauss, Jonathan B., & others, and. Comparison and Consensus Guidelines for Delineation of Clinical Target Volume for CT- and MR-Based Brachytherapy in Locally Advanced Cervical Cancer. United States. https://doi.org/10.1016/J.IJROBP.2014.06.005
Viswanathan, Akila N., E-mail: aviswanathan@lroc.harvard.edu, Erickson, Beth, Gaffney, David K., Beriwal, Sushil, Bhatia, Sudershan K., Lee Burnett, Omer, D'Souza, David P., Patil, Nikhilesh, Haddock, Michael G., Jhingran, Anuja, Jones, Ellen L., Kunos, Charles A., Lee, Larissa J., Lin, Lilie L., Mayr, Nina A., Petersen, Ivy, Petric, Primoz, Department of Radiation Oncology, National Center for Cancer Care and Research, Doha, Portelance, Lorraine, Small, William, Strauss, Jonathan B., and others, and. 2014. "Comparison and Consensus Guidelines for Delineation of Clinical Target Volume for CT- and MR-Based Brachytherapy in Locally Advanced Cervical Cancer". United States. https://doi.org/10.1016/J.IJROBP.2014.06.005.
@article{osti_22423816,
title = {Comparison and Consensus Guidelines for Delineation of Clinical Target Volume for CT- and MR-Based Brachytherapy in Locally Advanced Cervical Cancer},
author = {Viswanathan, Akila N., E-mail: aviswanathan@lroc.harvard.edu and Erickson, Beth and Gaffney, David K. and Beriwal, Sushil and Bhatia, Sudershan K. and Lee Burnett, Omer and D'Souza, David P. and Patil, Nikhilesh and Haddock, Michael G. and Jhingran, Anuja and Jones, Ellen L. and Kunos, Charles A. and Lee, Larissa J. and Lin, Lilie L. and Mayr, Nina A. and Petersen, Ivy and Petric, Primoz and Department of Radiation Oncology, National Center for Cancer Care and Research, Doha and Portelance, Lorraine and Small, William and Strauss, Jonathan B. and others, and},
abstractNote = {Objective: To create and compare consensus clinical target volume (CTV) contours for computed tomography (CT) and 3-Tesla (3-T) magnetic resonance (MR) image-based cervical-cancer brachytherapy. Methods and Materials: Twenty-three experts in gynecologic radiation oncology contoured the same 3 cervical cancer brachytherapy cases: 1 stage IIB near-complete response (CR) case with a tandem and ovoid, 1 stage IIB partial response (PR) case with tandem and ovoid with needles, and 1 stage IB2 CR case with a tandem and ring applicator. The CT contours were completed before the MRI contours. These were analyzed for consistency and clarity of target delineation using an expectation maximization algorithm for simultaneous truth and performance level estimation (STAPLE), with κ statistics as a measure of agreement between participants. The conformity index was calculated for each of the 6 data sets. Dice coefficients were generated to compare the CT and MR contours of the same case. Results: For all 3 cases, the mean tumor volume was smaller on MR than on CT (P<.001). The κ and conformity index estimates were slightly higher for CT, indicating a higher level of agreement on CT. The Dice coefficients were 89% for the stage IB2 case with a CR, 74% for the stage IIB case with a PR, and 57% for the stage IIB case with a CR. Conclusion: In a comparison of MR-contoured with CT-contoured CTV volumes, the higher level of agreement on CT may be due to the more distinct contrast medium visible on the images at the time of brachytherapy. MR at the time of brachytherapy may be of greatest benefit in patients with large tumors with parametrial extension that have a partial or complete response to external beam. On the basis of these results, a 95% consensus volume was generated for CT and for MR. Online contouring atlases are available for instruction at (http://www.nrgoncology.org/Resources/ContouringAtlases/GYNCervicalBrachytherapy.aspx)},
doi = {10.1016/J.IJROBP.2014.06.005},
url = {https://www.osti.gov/biblio/22423816}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 2,
volume = 90,
place = {United States},
year = {Wed Oct 01 00:00:00 EDT 2014},
month = {Wed Oct 01 00:00:00 EDT 2014}
}