Proposal for the delineation of neoadjuvant target volumes in oesophageal cancer

Melissa Thomas; Hanna R Mortensen; Lone Hoffmann; Ditte S Møller; Esther G C Troost; Christina T Muijs; Maaike Berbee; Rebecca Bütof; Owen Nicholas; Ganesh Radhakrishna; Gilles Defraene; Philippe Nafteux; Marianne Nordsmark; Karin Haustermans

doi:10.1016/j.radonc.2020.11.032

Proposal for the delineation of neoadjuvant target volumes in oesophageal cancer

Radiother Oncol. 2021 Mar:156:102-112. doi: 10.1016/j.radonc.2020.11.032. Epub 2020 Dec 5.

Authors

Affiliations

¹ KU Leuven - University of Leuven, Department of Oncology - Laboratory of Experimental Radiotherapy, Belgium; University Hospitals Leuven, Department of Radiation Oncology, Belgium. Electronic address: melissa.thomas@uzleuven.be.
² Aarhus University Hospital, Danish Center of Particle Therapy, Denmark.
³ Aarhus University Hospital, Department of Oncology, Denmark.
⁴ Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, and Helmholtz-Zentrum Dresden-Rossendorf, Germany; Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Germany.
⁵ University Medical Center Groningen, University of Groningen, Department of Radiation Oncology, The Netherlands.
⁶ Maastricht University Medical Centre, Department of Radiation Oncology (Maastro), GROW School for Oncology, the Netherlands.
⁷ Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, and Helmholtz-Zentrum Dresden-Rossendorf, Germany.
⁸ Swansea NHS Trust, Department of Clinical Oncology, Swansea, UK.
⁹ Christie NHS Foundation Trust, Department of Clinical Oncology, Manchester, UK.
¹⁰ KU Leuven - University of Leuven, Department of Oncology - Laboratory of Experimental Radiotherapy, Belgium.
¹¹ University Hospitals Leuven, Department of Thoracic Surgery, Belgium.
¹² KU Leuven - University of Leuven, Department of Oncology - Laboratory of Experimental Radiotherapy, Belgium; University Hospitals Leuven, Department of Radiation Oncology, Belgium.

PMID: 33285194
DOI: 10.1016/j.radonc.2020.11.032

Abstract

Purpose: To define instructions for delineation of target volumes in the neoadjuvant setting in oesophageal cancer.

Materials and methods: Radiation oncologists of five European centres participated in the following consensus process: [1] revision of published (MEDLINE) and national/institutional delineation guidelines; [2] first delineation round of five cases (patient 1-5) according to national/institutional guidelines; [3] consensus meeting to discuss the results of step 1 and 2, followed by a target volume delineation proposal; [4] circulation of proposed instructions for target volume delineation and atlas for feedback; [5] second delineation round of five new cases (patient 6-10) to peer review and validate (two additional centres) the agreed delineation guidelines and atlas; [6] final consensus on the delineation guidelines depicted in an atlas. Target volumes of the delineation rounds were compared between centres by Dice similarity coefficient (DSC) and maximum/mean undirected Hausdorff distances (H_max/H_mean).

Results: In the first delineation round, the consistency between centres was moderate (CTVtotal: DSC = 0.59-0.88; H_mean = 0.2-0.4 cm). Delineations in the second round were much more consistent. Lowest variability was obtained between centres participating in the consensus meeting (CTVtotal: DSC: p < 0.050 between rounds for patients 6/7/8/10; H_mean: p < 0.050 for patients 7/8/10), compared to validation centres (CTVtotal: DSC: p < 0.050 between validation and consensus meeting centres for patients 6/7/8; H_mean: p < 0.050 for patients 7/10). A proposal for delineation of target volumes and an atlas were generated.

Conclusion: We proposed instructions for target volume delineation and an atlas for the neoadjuvant radiation treatment in oesophageal cancer. These will enable a more uniform delineation of patients in clinical practice and clinical trials.

Keywords: Consensus; Delineation atlas; Neoadjuvant chemoradiation; Oesophageal cancer; Proposal for delineation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Consensus
Esophageal Neoplasms* / diagnostic imaging
Esophageal Neoplasms* / radiotherapy
Humans
Neoadjuvant Therapy*
Observer Variation
Radiation Oncologists
Radiotherapy Planning, Computer-Assisted