Comparison and consensus guidelines for delineation of clinical target volume for CT- and MR-based brachytherapy in locally advanced cervical cancer

Akila N. Viswanathan, Beth Erickson, David K. Gaffney, Sushil Beriwal, Sudershan K. Bhatia, Omer Lee Burnett, David P. D'Souza, Nikhilesh Patil, Michael G. Haddock, Anuja Jhingran, Ellen L. Jones, Charles A. Kunos, Larissa J. Lee, Lilie L. Lin, Nina A. Mayr, Ivy Petersen, Primoz Petric, Lorraine Portelance, William Small, Jonathan B. StraussKanokpis Townamchai, Aaron Wolfson, Catheryn M. Yashar, Walter Bosch

Research output: Contribution to journalArticle

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Abstract

Objective: To create and compare consensus clinical target volume (CTV) contours for computed tomography (CT) and 3-Tesla (3-T) magnetic resonance (MR) image-based cervical-cancer brachytherapy.

Methods and Materials: Twenty-three experts in gynecologic radiation oncology contoured the same 3 cervical cancer brachytherapy cases: 1 stage IIB near-complete response (CR) case with a tandem and ovoid, 1 stage IIB partial response (PR) case with tandem and ovoid with needles, and 1 stage IB2 CR case with a tandem and ring applicator. The CT contours were completed before the MRI contours. These were analyzed for consistency and clarity of target delineation using an expectation maximization algorithm for simultaneous truth and performance level estimation (STAPLE), with κ statistics as a measure of agreement between participants. The conformity index was calculated for each of the 6 data sets. Dice coefficients were generated to compare the CT and MR contours of the same case.

Results: For all 3 cases, the mean tumor volume was smaller on MR than on CT (P<.001). The κ and conformity index estimates were slightly higher for CT, indicating a higher level of agreement on CT. The Dice coefficients were 89% for the stage IB2 case with a CR, 74% for the stage IIB case with a PR, and 57% for the stage IIB case with a CR.

Conclusion: In a comparison of MR-contoured with CT-contoured CTV volumes, the higher level of agreement on CT may be due to the more distinct contrast medium visible on the images at the time of brachytherapy. MR at the time of brachytherapy may be of greatest benefit in patients with large tumors with parametrial extension that have a partial or complete response to external beam. On the basis of these results, a 95% consensus volume was generated for CT and for MR. Online contouring atlases are available for instruction at http://www.nrgoncology.org/Resources/ContouringAtlases/GYNCervicalBrachytherapy.aspx.

Original languageEnglish
Pages (from-to)320-328
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume90
Issue number2
DOIs
StatePublished - Jan 1 2014

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Cone-Beam Computed Tomography
delineation
Brachytherapy
Uterine Cervical Neoplasms
magnetic resonance
Magnetic Resonance Spectroscopy
tomography
cancer
Tomography
Guidelines
tumors
Radiation Oncology
Atlases
clarity
Tumor Burden
coefficients
Contrast Media
Needles
needles
resources

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Comparison and consensus guidelines for delineation of clinical target volume for CT- and MR-based brachytherapy in locally advanced cervical cancer. / Viswanathan, Akila N.; Erickson, Beth; Gaffney, David K.; Beriwal, Sushil; Bhatia, Sudershan K.; Lee Burnett, Omer; D'Souza, David P.; Patil, Nikhilesh; Haddock, Michael G.; Jhingran, Anuja; Jones, Ellen L.; Kunos, Charles A.; Lee, Larissa J.; Lin, Lilie L.; Mayr, Nina A.; Petersen, Ivy; Petric, Primoz; Portelance, Lorraine; Small, William; Strauss, Jonathan B.; Townamchai, Kanokpis; Wolfson, Aaron; Yashar, Catheryn M.; Bosch, Walter.

In: International Journal of Radiation Oncology Biology Physics, Vol. 90, No. 2, 01.01.2014, p. 320-328.

Research output: Contribution to journalArticle

Viswanathan, AN, Erickson, B, Gaffney, DK, Beriwal, S, Bhatia, SK, Lee Burnett, O, D'Souza, DP, Patil, N, Haddock, MG, Jhingran, A, Jones, EL, Kunos, CA, Lee, LJ, Lin, LL, Mayr, NA, Petersen, I, Petric, P, Portelance, L, Small, W, Strauss, JB, Townamchai, K, Wolfson, A, Yashar, CM & Bosch, W 2014, 'Comparison and consensus guidelines for delineation of clinical target volume for CT- and MR-based brachytherapy in locally advanced cervical cancer', International Journal of Radiation Oncology Biology Physics, vol. 90, no. 2, pp. 320-328. https://doi.org/10.1016/j.ijrobp.2014.06.005
Viswanathan, Akila N. ; Erickson, Beth ; Gaffney, David K. ; Beriwal, Sushil ; Bhatia, Sudershan K. ; Lee Burnett, Omer ; D'Souza, David P. ; Patil, Nikhilesh ; Haddock, Michael G. ; Jhingran, Anuja ; Jones, Ellen L. ; Kunos, Charles A. ; Lee, Larissa J. ; Lin, Lilie L. ; Mayr, Nina A. ; Petersen, Ivy ; Petric, Primoz ; Portelance, Lorraine ; Small, William ; Strauss, Jonathan B. ; Townamchai, Kanokpis ; Wolfson, Aaron ; Yashar, Catheryn M. ; Bosch, Walter. / Comparison and consensus guidelines for delineation of clinical target volume for CT- and MR-based brachytherapy in locally advanced cervical cancer. In: International Journal of Radiation Oncology Biology Physics. 2014 ; Vol. 90, No. 2. pp. 320-328.
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T1 - Comparison and consensus guidelines for delineation of clinical target volume for CT- and MR-based brachytherapy in locally advanced cervical cancer

AU - Viswanathan, Akila N.

AU - Erickson, Beth

AU - Gaffney, David K.

AU - Beriwal, Sushil

AU - Bhatia, Sudershan K.

AU - Lee Burnett, Omer

AU - D'Souza, David P.

AU - Patil, Nikhilesh

AU - Haddock, Michael G.

AU - Jhingran, Anuja

AU - Jones, Ellen L.

AU - Kunos, Charles A.

AU - Lee, Larissa J.

AU - Lin, Lilie L.

AU - Mayr, Nina A.

AU - Petersen, Ivy

AU - Petric, Primoz

AU - Portelance, Lorraine

AU - Small, William

AU - Strauss, Jonathan B.

AU - Townamchai, Kanokpis

AU - Wolfson, Aaron

AU - Yashar, Catheryn M.

AU - Bosch, Walter

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N2 - Objective: To create and compare consensus clinical target volume (CTV) contours for computed tomography (CT) and 3-Tesla (3-T) magnetic resonance (MR) image-based cervical-cancer brachytherapy.Methods and Materials: Twenty-three experts in gynecologic radiation oncology contoured the same 3 cervical cancer brachytherapy cases: 1 stage IIB near-complete response (CR) case with a tandem and ovoid, 1 stage IIB partial response (PR) case with tandem and ovoid with needles, and 1 stage IB2 CR case with a tandem and ring applicator. The CT contours were completed before the MRI contours. These were analyzed for consistency and clarity of target delineation using an expectation maximization algorithm for simultaneous truth and performance level estimation (STAPLE), with κ statistics as a measure of agreement between participants. The conformity index was calculated for each of the 6 data sets. Dice coefficients were generated to compare the CT and MR contours of the same case.Results: For all 3 cases, the mean tumor volume was smaller on MR than on CT (P<.001). The κ and conformity index estimates were slightly higher for CT, indicating a higher level of agreement on CT. The Dice coefficients were 89% for the stage IB2 case with a CR, 74% for the stage IIB case with a PR, and 57% for the stage IIB case with a CR.Conclusion: In a comparison of MR-contoured with CT-contoured CTV volumes, the higher level of agreement on CT may be due to the more distinct contrast medium visible on the images at the time of brachytherapy. MR at the time of brachytherapy may be of greatest benefit in patients with large tumors with parametrial extension that have a partial or complete response to external beam. On the basis of these results, a 95% consensus volume was generated for CT and for MR. Online contouring atlases are available for instruction at http://www.nrgoncology.org/Resources/ContouringAtlases/GYNCervicalBrachytherapy.aspx.

AB - Objective: To create and compare consensus clinical target volume (CTV) contours for computed tomography (CT) and 3-Tesla (3-T) magnetic resonance (MR) image-based cervical-cancer brachytherapy.Methods and Materials: Twenty-three experts in gynecologic radiation oncology contoured the same 3 cervical cancer brachytherapy cases: 1 stage IIB near-complete response (CR) case with a tandem and ovoid, 1 stage IIB partial response (PR) case with tandem and ovoid with needles, and 1 stage IB2 CR case with a tandem and ring applicator. The CT contours were completed before the MRI contours. These were analyzed for consistency and clarity of target delineation using an expectation maximization algorithm for simultaneous truth and performance level estimation (STAPLE), with κ statistics as a measure of agreement between participants. The conformity index was calculated for each of the 6 data sets. Dice coefficients were generated to compare the CT and MR contours of the same case.Results: For all 3 cases, the mean tumor volume was smaller on MR than on CT (P<.001). The κ and conformity index estimates were slightly higher for CT, indicating a higher level of agreement on CT. The Dice coefficients were 89% for the stage IB2 case with a CR, 74% for the stage IIB case with a PR, and 57% for the stage IIB case with a CR.Conclusion: In a comparison of MR-contoured with CT-contoured CTV volumes, the higher level of agreement on CT may be due to the more distinct contrast medium visible on the images at the time of brachytherapy. MR at the time of brachytherapy may be of greatest benefit in patients with large tumors with parametrial extension that have a partial or complete response to external beam. On the basis of these results, a 95% consensus volume was generated for CT and for MR. Online contouring atlases are available for instruction at http://www.nrgoncology.org/Resources/ContouringAtlases/GYNCervicalBrachytherapy.aspx.

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