Inter-clinician delineation variation for a new highly-conformal flank target volume in children with renal tumors: A SIOP-Renal Tumor Study Group international multicenter exercise.
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Authors
Mul, JoeriMelchior, Patrick
Seravalli, Enrica
Saunders, Daniel
Bolle, Stephanie
Cameron, Alison L
Gurtner, Kristin
Harrabi, Semi
Lassen-Ramshad, Yasmin
Lavan, Naomi
Magelssen, Henriette
Mandeville, Henry
Boterberg, Tom
Kroon, Petra S
Kotte, Alexis N T J
Hoeben, Bianca A W
van Rossum, Peter S N
van Grotel, Martine
Graf, Norbert
van den Heuvel-Eibrink, Marry M
Rübe, Christian
Janssens, Geert O
Issue Date
2021-03-11Keywords
AA, abdominal aortaAP/PA, Anterior-Posterior/Posterior-Anterior
CT, Computed Tomography
CTV-N, Clinical Target Volume of the lymph node area
CTV-T, Clinical Target Volume of the primary Tumor
DICOM, Digital Imaging and Communications in Medicine
DSC, Dice Similarity Coefficient
Flank target volume
GTVpre/post, pre- and postoperative Gross Tumor Volume respectively
HR, High-Risk
Highly-conformal radiotherapy
IGRT, Image-Guided Radiotherapy
IMRT, Intensity-Modulated Radiotherapy
IR, Intermediate-Risk
IVC, inferior vena cava
Inter-clinician variation
MRI, Magnetic Resonance Imaging
OAR, organs at risk
Pediatric renal tumors
QUALITY ASSURANCE
RT, radiotherapy
RTOG, Radiation Oncology Group
RTSG, Renal Tumor Study Group
SIOP, International Society for Pediatric Oncology
TVintersect, intersect target volume
TVref, reference target volumes
WT, Wilms’ tumor
Wilms tumor
n.a., not applicable
part, participant
ref, reference
Metadata
Show full item recordJournal
Clinical and translational radiation oncologyDOI
10.1016/j.ctro.2021.03.001PubMed ID
33796796Abstract
Background and purpose: Recently, the SIOP-RTSG developed a highly-conformal flank target volume definition for children with renal tumors. The aims of this study were to evaluate the inter-clinician delineation variation of this new target volume definition in an international multicenter setting and to explore the necessity of quality assurance. Materials and methods: Six pediatric renal cancer cases were transferred to ten radiation oncologists from seven European countries ('participants'). These participants delineated the pre- and postoperative Gross Tumor Volume (GTVpre/post), and Clinical Target Volume (CTV) during two test phases (case 1-2 and 3-4), followed by guideline refinement and a quality assurance phase (case 5-6). Reference target volumes (TVref) were established by three experienced radiation oncologists. The Dice Similarity Coefficient between the reference and participants (DSCref/part) was calculated per case. Delineations of case 5-6 were graded by four independent reviewers as 'per protocol' (0-4 mm), 'minor deviation' (5-9 mm) or 'major deviation' (≥10 mm) from the delineation guideline using 18 standardized criteria. Also, a major deviation resulting in underestimation of the CTVref was regarded as an unacceptable variation. Results: A total of 57/60 delineation sets were completed. The median DSCref/part for the CTV was 0.55 without improvement after sequential cases (case 3-4 vs. case 5-6: p = 0.15). For case 5-6, a major deviation was found for 5/18, 12/17, 18/18 and 4/9 collected delineations of the GTVpre, GTVpost, CTV-T and CTV-N, respectively. An unacceptable variation from the CTVref was found for 7/9 participants for case 5 and 6/9 participants for case 6. Conclusion: This international multicenter delineation exercise demonstrates that the new consensus for highly-conformal postoperative flank target volume delineation leads to geometrical variation among participants. Moreover, standardized review showed an unacceptable delineation variation in the majority of the participants. These findings strongly suggest the need for additional training and centralized pre-treatment review when this target volume delineation approach is implemented on a larger scale.Item Type
ArticleLanguage
enEISSN
2405-6308ae974a485f413a2113503eed53cd6c53
10.1016/j.ctro.2021.03.001
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