An in-silico quality assurance study of contouring target volumes in thoracic tumors within a cooperative group setting
Year: 2019
Type: article
Abstract: Introduction Target delineation variability is a significant technical impediment in multi-institutional trials which employ intensity modulated radiotherapy (IMRT), as there is a real potential for clinically meaningful variances that can impact the outcomes in clinical trials. The goal of this study is to determine the variability of target delineation among participants from different institutions as part of Southwest Oncology Group (SWOG) Radiotherapy Committee's multi-institutional in-silico quality assurance study in patients with Pancoast tumors as a "dry run" for trial implementation. Methods CT simulation scans were acquired from four patients with Pancoast tumor. Two patients had simulation 4D-CT and FDG-FDG PET-CT while two patients had 3D-CT and FDG-FDG PET-CT. Seventeen SWOG-affiliated physicians independently delineated target volumes defined as gross primary and nodal tumor volumes (GTV_P & GTV_N), clinical target volume (CTV), and planning target volume (PTV). Six board-certified thoracic radiation oncologists were designated as the ‘Experts' for this study. Their delineations were used to create a simultaneous truth and performance level estimation (STAPLE) contours using ADMIRE software (Elekta AB, Sweden 2017). Individual participants' contours were then compared with Experts' STAPLE contours. Results When compared to the Experts' STAPLE, GTV_P had the best agreement among all participants, while GTV_N showed the lowest agreement among all participants. There were no statistically significant differences in all studied parameters for all TVs for cases with 4D-CT versus cases with 3D-CT simulation scans. Conclusions High degree of inter-observer variation was noted for all target volume except for GTV_P, unveiling potentials for protocol modification for subsequent clinically meaningful improvement in target definition. Various similarity indices exist that can be used to guide multi-institutional radiotherapy delineation QA credentialing.
Authors: Hesham Elhalawani, Baher Elgohari, Timothy A. Lin, Abdallah S.R. Mohamed, Thomas J. Fitzgerald, Fran Laurie, Kenneth Ulin, Jayashree Kalpathy-Cramer, Thomas Guerrero, Emma B. Holliday, Gregory Russo, Abhilasha Patel, William Jones, Gary V. Walker, Musaddiq Awan, Mehee Choi, Roi Dagan, Omar Mahmoud, Anna Shapiro, Feng-Ming (Spring) Kong, Daniel Gomez, Jing Zeng, Roy Decker, Femke O.B. Spoelstra, Laurie E. Gaspar, Lisa A. Kachnic, Charles R. Thomas, Paul Okunieff, Clifton D. Fuller
Institutions: The University of Texas MD Anderson Cancer Center, Baylor College of Medicine, Alexandria University, University of Massachusetts Chan Medical School, Harvard University, Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Beaumont Health, Boston Medical Center, The University of Texas at San Antonio Health Science Center, Banner MD Anderson Cancer Center, Case Western Reserve University, Northwestern University, University of Florida Health, University of Florida Health Science Center, University of Miami, SUNY Upstate Medical University, University Hospitals of Cleveland, University Hospitals Cleveland Medical Center, University of Washington Medical Center, Yale University, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam UMC Location Vrije Universiteit Amsterdam, Vanderbilt University, Vanderbilt University Medical Center, Oregon Health & Science University, University of Florida
Language: English
Subfield: Radiation
Field: Physics and Astronomy
Domain: Physical Sciences
Open Access status: gold
Estimated APC paid: $560
Funders: American Society for Radiation Oncology, Sabin Vaccine Institute, American Society of Clinical Oncology, Andrew Sabin Family Foundation, Hope Foundation, National Institutes of Health, University of Texas MD Anderson Cancer Center, National Cancer Institute, National Institute of Biomedical Imaging and Bioengineering, National Institute of Dental and Craniofacial Research
Awards: G111615301, G1607744604, G1858909031, Informatics Tools for Optimized Imaging Biomarkers for Cancer Research&Discovery, G1938688226, G203557288, G2326049341, G2509465741, G2554729840, M D Anderson Cancer Center Head & Neck SPORE, G441914509, SMART-ACT: Spatial Methodologic Approaches for Risk Assessment and Therapeutic Adaptation in Cancer Treatment, imaging Radiation-Associated Dysphagia (iRAD), G7821738775, G842568704, G9000034222, G9000141638, G940070239
OpenAlex ID: W2906844468