肝癌伴或不伴门静脉癌栓的靶区勾画的观察者间变异性：放射肿瘤学组共识指南。
Interobserver variability in target definition for hepatocellular carcinoma with and without portal vein thrombus: radiation therapy oncology group consensus guidelines.
机构信息
Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Department of Radiation Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
出版信息
Int J Radiat Oncol Biol Phys. 2014 Jul 15;89(4):804-13. doi: 10.1016/j.ijrobp.2014.03.041.
PURPOSE
Defining hepatocellular carcinoma (HCC) gross tumor volume (GTV) requires multimodal imaging, acquired in different perfusion phases. The purposes of this study were to evaluate the variability in contouring and to establish guidelines and educational recommendations for reproducible HCC contouring for treatment planning.
METHODS AND MATERIALS
Anonymous, multiphasic planning computed tomography scans obtained from 3 patients with HCC were identified and distributed to a panel of 11 gastrointestinal radiation oncologists. Panelists were asked the number of HCC cases they treated in the past year. Case 1 had no vascular involvement, case 2 had extensive portal vein involvement, and case 3 had minor branched portal vein involvement. The agreement between the contoured total GTVs (primary + vascular GTV) was assessed using the generalized kappa statistic. Agreement interpretation was evaluated using Landis and Koch's interpretation of strength of agreement. The S95 contour, defined using the simultaneous truth and performance level estimation (STAPLE) algorithm consensus at the 95% confidence level, was created for each case.
RESULTS
Of the 11 panelists, 3 had treated >25 cases in the past year, 2 had treated 10 to 25 cases, 2 had treated 5 to 10 cases, 2 had treated 1 to 5 cases, 1 had treated 0 cases, and 1 did not respond. Near perfect agreement was seen for case 1, and substantial agreement was seen for cases 2 and 3. For case 2, there was significant heterogeneity in the volume identified as tumor thrombus (range 0.58-40.45 cc). For case 3, 2 panelists did not include the branched portal vein thrombus, and 7 panelists contoured thrombus separately from the primary tumor, also showing significant heterogeneity in volume of tumor thrombus (range 4.52-34.27 cc).
CONCLUSIONS
In a group of experts, excellent agreement was seen in contouring total GTV. Heterogeneity exists in the definition of portal vein thrombus that may impact treatment planning, especially if differential dosing is contemplated. Guidelines for HCC GTV contouring are recommended.
目的
定义肝细胞癌（HCC）的大体肿瘤体积（GTV）需要多模态成像，在不同的灌注阶段获得。本研究的目的是评估轮廓的可变性，并为 HCC 轮廓的可重复性制定指南和教育建议，以用于治疗计划。
方法和材料
从 3 例 HCC 患者中识别并分发匿名、多期计划 CT 扫描给一个由 11 名胃肠放射肿瘤学家组成的小组。小组成员被问到他们在过去一年中治疗了多少例 HCC 病例。病例 1 无血管受累，病例 2 广泛门静脉受累，病例 3 有少量分支门静脉受累。使用广义kappa 统计评估总 GTV（原发性+血管 GTV）的轮廓一致性。使用 Landis 和 Koch 的一致性强度解释评估一致性解释。为每个病例创建了使用同步真实和性能水平估计（STAPLE）算法共识的 S95 轮廓，置信度为 95%。
结果
11 名小组成员中，有 3 名过去一年治疗的病例超过 25 例，有 2 名治疗 10 至 25 例，有 2 名治疗 5 至 10 例，有 2 名治疗 1 至 5 例，有 1 名治疗 0 例，有 1 名未回复。病例 1 显示出近乎完美的一致性，病例 2 和病例 3 显示出显著的一致性。对于病例 2，确定肿瘤血栓的体积存在显著的异质性（范围为 0.58-40.45cc）。对于病例 3，有 2 名小组成员未包括分支门静脉血栓，有 7 名小组成员将门静脉血栓与原发性肿瘤分开勾画，也显示出肿瘤血栓体积的显著异质性（范围为 4.52-34.27cc）。
结论
在一组专家中，总 GTV 的勾画显示出极好的一致性。门静脉血栓的定义存在异质性，这可能会影响治疗计划，特别是如果考虑到差异剂量。建议制定 HCC GTV 勾画指南。
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