Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
J Appl Clin Med Phys. 2024 Sep;25(9):e14474. doi: 10.1002/acm2.14474. Epub 2024 Jul 29.
The delineation of clinical target volumes (CTVs) for radiotherapy for nasopharyngeal cancer is complex and varies based on the location and extent of disease.
The current study aimed to develop an auto-contouring solution following one protocol guidelines (NRG-HN001) that can be adjusted to meet other guidelines, such as RTOG-0225 and the 2018 International guidelines.
The study used 2-channel 3-dimensional U-Net and nnU-Net framework to auto-contour 27 normal structures in the head and neck (H&N) region that are used to define CTVs in the protocol. To define the CTV-Expansion (CTV1 and CTV2) and CTV-Overall (the outer envelope of all the CTV contours), we used adjustable morphological geometric landmarks and mimicked physician interpretation of the protocol rules by partially or fully including select anatomic structures. The results were evaluated quantitatively using the dice similarity coefficient (DSC) and mean surface distance (MSD) and qualitatively by independent reviews by two H&N radiation oncologists.
The auto-contouring tool showed high accuracy for nasopharyngeal CTVs. Comparison between auto-contours and clinical contours for 19 patients with cancers of various stages showed a DSC of 0.94 ± 0.02 and MSD of 0.4 ± 0.4 mm for CTV-Expansion and a DSC of 0.83 ± 0.02 and MSD of 2.4 ± 0.5 mm for CTV-Overall. Upon independent review, two H&N physicians found the auto-contours to be usable without edits in 85% and 75% of cases. In 15% of cases, minor edits were required by both physicians. Thus, one physician rated 100% of the auto-contours as usable (use as is, or after minor edits), while the other physician rated 90% as usable. The second physician required major edits in 10% of cases.
The study demonstrates the ability of an auto-contouring tool to reliably delineate nasopharyngeal CTVs based on protocol guidelines. The tool was found to be clinically acceptable by two H&N radiation oncology physicians in at least 90% of the cases.
鼻咽癌放射治疗的临床靶区（CTV）勾画较为复杂，并且根据疾病的位置和范围而有所不同。
本研究旨在根据 NRG-HN001 方案指南开发一种自动勾画解决方案，该方案可根据 RTOG-0225 和 2018 年国际指南等其他指南进行调整。
该研究使用双通道 3D U-Net 和 nnU-Net 框架自动勾画头部和颈部（H&N）区域的 27 个正常结构，这些结构用于定义方案中的 CTV。为了定义 CTV-Expansion（CTV1 和 CTV2）和 CTV-Overall（所有 CTV 轮廓的外轮廓），我们使用了可调节的形态几何标志，并通过部分或完全包括选择的解剖结构来模拟医生对方案规则的解释。使用 Dice 相似系数（DSC）和平均表面距离（MSD）对结果进行定量评估，并由两名 H&N 放射肿瘤学家进行独立审查进行定性评估。
自动勾画工具对鼻咽癌 CTV 具有很高的准确性。对 19 名不同分期癌症患者的自动勾画和临床勾画进行比较，CTV-Expansion 的 DSC 为 0.94±0.02，MSD 为 0.4±0.4mm；CTV-Overall 的 DSC 为 0.83±0.02，MSD 为 2.4±0.5mm。两名 H&N 医生独立审查后发现，在 85%和 75%的病例中，自动勾画无需编辑即可使用。在 15%的病例中，两位医生都需要进行小的编辑。因此，一位医生认为 100%的自动勾画可以使用（直接使用或经过小的编辑），而另一位医生则认为 90%的自动勾画可以使用。第二位医生在 10%的病例中需要进行大的编辑。
该研究表明，自动勾画工具能够根据方案指南可靠地勾画鼻咽癌 CTV。两位 H&N 放射肿瘤医生认为，该工具在至少 90%的病例中具有临床可接受性。
