Franco Pierfrancesco, Arcadipane Francesca, Trino Elisabetta, Gallio Elena, Martini Stefania, Iorio Giuseppe Carlo, Piva Cristina, Moretto Francesco, Ruo Redda Maria Grazia, Verna Roberta, Tseroni Vassiliki, Bona Cristina, Pozzi Gabriele, Fiandra Christian, Ragona Riccardo, Bertetto Oscar, Ricardi Umberto
Department of Oncology, Radiation Oncology, University of Turin, AOU Citta' della salute e della Scienza, Turin, Italy.
Department of Oncology, Radiation Oncology, AOU Citta' della Salute e della Scienza, Turin, Italy.
Clin Transl Radiat Oncol. 2018 Jun 11;11:33-39. doi: 10.1016/j.ctro.2018.06.002. eCollection 2018 Jun.
Delineation of treatment volumes is a major source of uncertainties in radiotherapy (RT). This is also true for rectal cancer patients undergoing neoadjuvant RT, with a potential impact on treatment quality. We investigated the role of the digital platform Anatom-e (Anatom-e Information Sytems Ltd., Houston, Texas) in increasing the compliance to follow a specific treatment protocol in a multicentric setting.
Two clinical cases of locally advanced rectal cancer were chosen. Participants were instructed to follow the 2009 Radiation Therapy Oncology Group consensus atlas and asked to manually segment clinical target volumes (CTVs), for both patient 1 and 2, on day 1 with and without the use of Anatom-e. After one week (day 2), the same radiation oncologist contoured again, with and without Anatom-e, the same CT series. Intraobserver (Intra-OV) and interobserver (Inter-OV) variability were evaluated with the Dice similarity coefficient (DSC), the Hausdorff distance (HD) and mean distance to agreement (MDA).
For clinical case 1, no significant difference was found for Intra-OV and Inter-OV. For clinical case 2, no significant difference was found for Intra-OV but a statistically significant difference was found for Inter-OV in DSC when using or not the platform. Mean DCS was 0.65 (SD: ±0.64; range: 0.58-0.79) for day 1 vs reference volume without Anatom-e and 0.72 (SD: ±0.39; range: 0.67-0.77) (p = 0.03) with it. Mean MDA was lower with Anatom-e (3.61; SD: ±1.33; range: 2.85-4.78) than without (4.14; SD: ±2.97; range: 2.18-5.21), with no statistical significance (p = 0.21) The use of Anatom-e decreased the SD from 2.97 to 1.33. Mean HD was lower with Anatom-e (26.06; SD: ±2.05; range: 24.08-32.62), with no statistical significance (p = 0.14) compared to that without (31.39; SD: ±1.31; range: 26.14-48.72).
The use of Anatom-e decreased the Inter-OV in the CTV delineation process for locally advanced rectal cancer with complex disease presentation planned for neoadjuvant RT. This system may be potentially helpful in increasing the compliance to follow shared guidelines and protocols.
确定治疗靶区是放射治疗（RT）中不确定性的主要来源。对于接受新辅助放疗的直肠癌患者也是如此，这可能会对治疗质量产生影响。我们研究了数字平台Anatom-e（Anatom-e信息系统有限公司，得克萨斯州休斯顿）在多中心环境中提高遵循特定治疗方案的依从性方面的作用。
选择两例局部晚期直肠癌的临床病例。参与者被要求遵循2009年放射肿瘤学组的共识图谱，并要求在第1天，无论有无Anatom-e的情况下，手动勾画患者1和患者2的临床靶区（CTV）。一周后（第2天），同一位放射肿瘤学家再次在有无Anatom-e的情况下，对相同的CT序列进行轮廓勾画。通过骰子相似系数（DSC）、豪斯多夫距离（HD）和平均一致距离（MDA）评估观察者内（Intra-OV）和观察者间（Inter-OV）的变异性。
对于临床病例1，观察者内和观察者间均未发现显著差异。对于临床病例2，观察者内未发现显著差异，但在使用或不使用该平台时，观察者间在DSC方面存在统计学显著差异。第1天与无Anatom-e的参考体积相比，平均DCS为0.65（标准差：±0.64；范围：0.58 - 0.79），使用Anatom-e时为0.72（标准差：±0.39；范围：0.67 - 0.77）（p = 0.03）。使用Anatom-e时平均MDA较低（3.61；标准差：±1.33；范围：2.85 - 4.78），不使用时为（4.14；标准差：±2.97；范围：2.18 - 5.21），无统计学意义（p = 0.21）。使用Anatom-e使标准差从2.97降至1.33。与不使用时（31.39；标准差：±1.31；范围：26.14 - 48.72）相比，使用Anatom-e时平均HD较低（26.06；标准差：±2.05；范围：24.08 - 32.62），无统计学意义（p = 0.14）。
对于计划进行新辅助放疗、具有复杂病情表现的局部晚期直肠癌，在CTV勾画过程中使用Anatom-e可降低观察者间的差异。该系统可能有助于提高遵循共享指南和方案的依从性。
