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Comparison and consensus guidelines for delineation of clinical target volume for CT- and MR-based brachytherapy in locally advanced cervical cancer
Journal article   Open access   Peer reviewed

Comparison and consensus guidelines for delineation of clinical target volume for CT- and MR-based brachytherapy in locally advanced cervical cancer

Akila N Viswanathan, Beth Erickson, David K Gaffney, Sushil Beriwal, Sudershan K Bhatia, Omer Lee Burnett, 3rd, David P D'Souza, Nikhilesh Patil, Michael G Haddock, Anuja Jhingran, …
International journal of radiation oncology, biology, physics, v 90(2), pp 320-328
01 Oct 2014
DOI: https://doi.org/10.1016/j.ijrobp.2014.06.005
PMID: 25304792
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.17615/r3fq-wd74View
Published, Version of Record (VoR)Open Access (License Unspecified),  Open

Abstract

Adenocarcinoma - diagnostic imaging Adenocarcinoma - pathology Adenocarcinoma - radiotherapy Brachytherapy - instrumentation Brachytherapy - methods Consensus Female Humans Magnetic Resonance Imaging - methods Neoplasm, Residual Tomography, X-Ray Computed Tumor Burden Uterine Cervical Neoplasms - diagnostic imaging Uterine Cervical Neoplasms - pathology Uterine Cervical Neoplasms - radiotherapy
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. 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. 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. 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.

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Domestic collaboration
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Web of Science research areas
Oncology
Radiology, Nuclear Medicine & Medical Imaging
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