Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
Radiation Oncology Unit, Hospital "Mons. A.R. Dimiccoli", Barletta, Italy.
Radiol Med. 2023 Mar;128(3):362-371. doi: 10.1007/s11547-023-01612-x. Epub 2023 Mar 6.
Target volume delineation in the radiation treatment of nasopharyngeal cancer is challenging due to several reasons such as the complex anatomy of the site, the need for the elective coverage of definite anatomical regions, the curative intent of treatment and the rarity of the disease, especially in non-endemic areas. We aimed to analyze the impact of educational interactive teaching courses on target volume delineation accuracy between Italian radiation oncology centers. Only one contour dataset per center was admitted. The educational course consisted in three parts: (1) The completely anonymized image dataset of a T4N1 nasopharyngeal cancer patient was shared between centers before the course with the request of target volume and organs at risk delineation; (2) the course was held online with dedicated multidisciplinary sessions on nasopharyngeal anatomy, nasopharyngeal cancer pattern of diffusion and on the description and explanation of international contouring guidelines. At the end of the course, the participating centers were asked to resubmit the contours with appropriate corrections; (3) the pre- and post-course contours were analyzed and quantitatively and qualitatively compared with the benchmark contours delineated by the panel of experts. The analysis of the 19 pre- and post-contours submitted by the participating centers revealed a significant improvement in the Dice similarity index in all the clinical target volumes (CTV1, CTV2 and CTV3) passing from 0.67, 0.51 and 0.48 to 0.69, 0.65 and 0.52, respectively. The organs at risk delineation was also improved. The qualitative analysis consisted in the evaluation of the inclusion of the proper anatomical regions in the target volumes; it was conducted following internationally validated guidelines of contouring for nasopharyngeal radiation treatment. All the sites were properly included in target volume delineation by >50% of the centers after correction. A significant improvement was registered for the skull base, the sphenoid sinus and the nodal levels. These results demonstrated the important role that educational courses with interactive sessions could have in such a challenging task as target volume delineation in modern radiation oncology.
由于多种原因，如该部位的复杂解剖结构、需要选择性覆盖明确的解剖区域、治疗的治愈意图以及疾病的罕见性，特别是在非流行地区，鼻咽癌的放射治疗靶区勾画具有挑战性。我们旨在分析教育互动教学课程对意大利放射肿瘤学中心靶区勾画准确性的影响。每个中心只允许提交一个轮廓数据集。该教育课程由三部分组成：（1）在课程之前，将一位 T4N1 鼻咽癌患者的完全匿名图像数据集在中心之间共享，并要求勾画靶区和危及器官；（2）课程在线进行，专门举办多学科会议，介绍鼻咽解剖学、鼻咽癌扩散模式以及国际勾画指南的描述和解释。课程结束后，要求参与中心重新提交带有适当更正的轮廓；（3）分析课前和课后的轮廓，并与专家组划定的基准轮廓进行定量和定性比较。分析参与中心提交的 19 个课前和课后轮廓显示，所有临床靶区（CTV1、CTV2 和 CTV3）的 Dice 相似指数均有显著提高，分别从 0.67、0.51 和 0.48 提高到 0.69、0.65 和 0.52。危及器官的勾画也得到了改善。定性分析包括评估适当的解剖区域是否包含在靶区中；它是按照国际上验证的鼻咽癌放射治疗勾画指南进行的。在纠正后，超过 50%的中心正确地将所有部位包括在靶区勾画中。颅底、蝶窦和淋巴结水平的勾画得到了显著改善。这些结果表明，在现代放射肿瘤学中，具有互动环节的教育课程在靶区勾画等具有挑战性的任务中可能发挥重要作用。
