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评估前列腺床放射治疗中轮廓变异性与模拟治疗结果之间的关系。

Evaluating the relationship between contouring variability and modelled treatment outcome for prostate bed radiotherapy.

机构信息

South Western Clinical School, University of New South Wales, Sydney, Australia.

Ingham Institute for Applied Medical Research, Sydney, Australia.

出版信息

Phys Med Biol. 2024 Apr 3;69(8). doi: 10.1088/1361-6560/ad3325.

Abstract

Contouring similarity metrics are often used in studies of inter-observer variation and automatic segmentation but do not provide an assessment of clinical impact. This study focused on post-prostatectomy radiotherapy and aimed to (1) identify if there is a relationship between variations in commonly used contouring similarity metrics and resulting dosimetry and (2) identify the variation in clinical target volume (CTV) contouring that significantly impacts dosimetry.The study retrospectively analysed CT scans of 10 patients from the TROG 08.03 RAVES trial. The CTV, rectum, and bladder were contoured independently by three experienced observers. Using these contours reference simultaneous truth and performance level estimation (STAPLE) volumes were established. Additional CTVs were generated using an atlas algorithm based on a single benchmark case with 42 manual contours. Volumetric-modulated arc therapy (VMAT) treatment plans were generated for the observer, atlas, and reference volumes. The dosimetry was evaluated using radiobiological metrics. Correlations between contouring similarity and dosimetry metrics were calculated using Spearman coefficient (Γ). To access impact of variations in planning target volume (PTV) margin, the STAPLE PTV was uniformly contracted and expanded, with plans created for each PTV volume. STAPLE dose-volume histograms (DVHs) were exported for plans generated based on the contracted/expanded volumes, and dose-volume metrics assessed.. The study found no strong correlations between the considered similarity metrics and modelled outcomes. Moderate correlations (0.5 <Γ< 0.7) were observed for Dice similarity coefficient, Jaccard, and mean distance to agreement metrics and rectum toxicities. The observations of this study indicate a tendency for variations in CTV contraction/expansion below 5 mm to result in minor dosimetric impacts.. Contouring similarity metrics must be used with caution when interpreting them as indicators of treatment plan variation. For post-prostatectomy VMAT patients, this work showed variations in contours with an expansion/contraction of less than 5 mm did not lead to notable dosimetric differences, this should be explored in a larger dataset to assess generalisability.

摘要

轮廓相似性度量指标常用于观察者间变异性和自动分割的研究中,但不能评估临床影响。本研究专注于前列腺癌术后放疗,旨在:(1) 确定常用轮廓相似性度量指标的变化与剂量学结果之间是否存在关系;(2) 确定对剂量学有显著影响的临床靶区(CTV)轮廓变化。该研究回顾性分析了来自 TROG 08.03 RAVES 试验的 10 例患者的 CT 扫描。三位有经验的观察者分别对 CTV、直肠和膀胱进行勾画。使用这些轮廓图,建立了参考同时真实和性能水平估计(STAPLE)体积。使用基于单个基准病例的图谱算法生成了额外的 CTV,该病例有 42 个手动轮廓。为观察者、图谱和参考体积生成容积调强弧形治疗(VMAT)治疗计划。使用放射生物学指标评估剂量学。使用 Spearman 系数(Γ)计算轮廓相似性和剂量学指标之间的相关性。为了评估计划靶区(PTV)边界变化的影响,对 STAPLE PTV 进行均匀收缩和扩展,并为每个 PTV 体积创建计划。导出基于收缩/扩展体积生成的计划的 STAPLE 剂量-体积直方图(DVH),并评估剂量-体积指标。研究发现,所考虑的相似性度量与模型结果之间没有很强的相关性。在 Dice 相似系数、Jaccard 和平均距离一致性度量以及直肠毒性方面观察到中度相关性(0.5<Γ<0.7)。本研究的观察结果表明,CTV 收缩/扩展变化小于 5mm 可能导致剂量学影响较小。在解释为治疗计划变化的指标时,必须谨慎使用轮廓相似性度量指标。对于前列腺癌术后 VMAT 患者,本工作表明,轮廓的扩展/收缩小于 5mm 的变化不会导致明显的剂量学差异,应在更大的数据集内进行探索,以评估其普遍性。

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