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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

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 (« less
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  1. Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts (United States)
  2. Medical College of Wisconsin, Milwaukee, Wisconsin (United States)
  3. University of Utah Huntsman Cancer Hospital, Salt Lake City, Utah (United States)
  4. University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States)
  5. University of Iowa, Iowa City, Iowa (United States)
  6. University of Alabama, Birmingham, Alabama (United States)
  7. London Health Sciences Centre and Western University, London, Ontario (Canada)
  8. Mayo Medical Center, Rochester, Minnesota (United States)
  9. University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
  10. University of North Carolina, Chapel Hill, North Carolina (United States)
  11. Case Western Reserve University, Cleveland, Ohio (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. (Qatar)
  16. University of Miami Miller School of Medicine, Miami, Florida (United States)
  17. Loyola University Strich School of Medicine, Chicago, Illinois (United States)
  18. The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois (United States)
Publication Date:
OSTI Identifier:
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; 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)
Country of Publication:
United States