KU Leuven - University of Leuven, Department of Oncology - Laboratory of Experimental Radiotherapy, Belgium; University Hospitals Leuven, Department of Radiation Oncology, Belgium.
Aarhus University Hospital, Danish Center of Particle Therapy, Denmark.
Radiother Oncol. 2021 Mar;156:102-112. doi: 10.1016/j.radonc.2020.11.032. Epub 2020 Dec 5.
To define instructions for delineation of target volumes in the neoadjuvant setting in oesophageal cancer.
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/H).
In the first delineation round, the consistency between centres was moderate (CTVtotal: DSC = 0.59-0.88; H = 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: 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: p < 0.050 for patients 7/10). A proposal for delineation of target volumes and an atlas were generated.
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.
为新辅助治疗食管癌的靶区勾画制定指导原则。
来自 5 个欧洲中心的放疗医生参与了以下共识过程：[1] 修订发表的文献（MEDLINE）和国家/机构勾画指南；[2] 根据国家/机构指南进行 5 例（患者 1-5）的首轮勾画；[3] 共识会议讨论步骤 1 和 2 的结果，然后提出靶区勾画建议；[4] 勾画靶区建议和图谱的反馈；[5] 对 5 例新患者（患者 6-10）进行第二轮勾画，同行评议和验证（另外 2 个中心）达成的勾画指南和图谱；[6] 在图谱上最终达成勾画指南的共识。通过 Dice 相似系数（DSC）和最大/平均无向 Hausdorff 距离（H/H）比较各中心勾画轮次之间的靶区差异。
首轮勾画中，各中心间的一致性为中度（CTVtotal：DSC=0.59-0.88；H=0.2-0.4cm）。第二轮勾画更具一致性。参加共识会议的中心间差异最小（CTVtotal：DSC：患者 6/7/8/10 时，组间比较 p<0.050；H：患者 7/8/10 时，组间比较 p<0.050），而验证中心间差异较大（CTVtotal：DSC：患者 6/7/8 时，验证和共识会议中心间比较 p<0.050；H：患者 7/10 时，组间比较 p<0.050）。提出了靶区勾画建议和图谱。
我们提出了新辅助治疗食管癌的靶区勾画指导原则和图谱。这将使患者在临床实践和临床试验中得到更统一的勾画。
