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Abstract
The delineation of organs at risk is the basis of radiotherapy oncologists' work. Indeed, the knowledge of this delineation enables to better identify the target volumes and to optimize dose distribution, involving the prognosis of the patients but also their future. The learning of this delineation must continue throughout the clinician's career. Some contour changes have appeared with better imaging, some volumes are now required due to development of knowledge of side effects. In addition, the increasing survival time of patients requires to be more systematic and precise in the delineations, both to avoid complications until now exceptional but also because re-irradiations are becoming more and more frequent. We present the update of the recommendations of the French Society for Radiation Oncology (SFRO) on new findings or adaptations to volumes at risk.
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Affiliation(s)
- G Noël
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, BP 23025, 67033 Strasbourg, France.
| | - C Le Fèvre
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, BP 23025, 67033 Strasbourg, France
| | - D Antoni
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, BP 23025, 67033 Strasbourg, France
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van der Veen J, Gulyban A, Willems S, Maes F, Nuyts S. Interobserver variability in organ at risk delineation in head and neck cancer. Radiat Oncol 2021; 16:120. [PMID: 34183040 PMCID: PMC8240214 DOI: 10.1186/s13014-020-01677-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/24/2020] [Indexed: 11/25/2022] Open
Abstract
Background In radiotherapy inaccuracy in organ at risk (OAR) delineation can impact treatment plan optimisation and treatment plan evaluation. Brouwer et al. showed significant interobserver variability (IOV) in OAR delineation in head and neck cancer (HNC) and published international consensus guidelines (ICG) for OAR delineation in 2015. The aim of our study was to evaluate IOV in the presence of these guidelines. Methods HNC radiation oncologists (RO) from each Belgian radiotherapy centre were invited to complete a survey and submit contours for 5 HNC cases. Reference contours (OARref) were obtained by a clinically validated artificial intelligence-tool trained using ICG. Dice similarity coefficients (DSC), mean surface distance (MSD) and 95% Hausdorff distances (HD95) were used for comparison. Results Fourteen of twenty-two RO (64%) completed the survey and submitted delineations. Thirteen (93%) confirmed the use of delineation guidelines, of which six (43%) used the ICG. The OARs whose delineations agreed best with the OARref were mandible [median DSC 0.9, range (0.8–0.9); median MSD 1.1 mm, range (0.8–8.3), median HD95 3.4 mm, range (1.5–38.7)], brainstem [median DSC 0.9 (0.6–0.9); median MSD 1.5 mm (1.1–4.0), median HD95 4.0 mm (2.3–15.0)], submandibular glands [median DSC 0.8 (0.5–0.9); median MSD 1.2 mm (0.9–2.5), median HD95 3.1 mm (1.8–12.2)] and parotids [median DSC 0.9 (0.6–0.9); median MSD 1.9 mm (1.2–4.2), median HD95 5.1 mm (3.1–19.2)]. Oral cavity, cochleas, PCMs, supraglottic larynx and glottic area showed more variation. RO who used the consensus guidelines showed significantly less IOV (p = 0.008). Conclusions Although ICG for delineation of OARs in HNC exist, they are only implemented by about half of RO participating in this study, which partly explains the delineation variability. However, this study highlights that guidelines alone do not suffice to eliminate IOV and that more effort needs to be done to accomplish further treatment standardisation, for example with artificial intelligence.
Supplementary information Supplementary information accompanies this paper at 10.1186/s13014-020-01677-2.
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Affiliation(s)
- J van der Veen
- Department of Oncology, Radiation-Oncology, University of Leuven, University Hospitals Leuven, 3000, Leuven, KU, Belgium
| | - A Gulyban
- Department of Medical Physics, Jules Bordet Institute, Brussels, Belgium.
| | - S Willems
- Department ESAT, Processing Speech and Images (PSI), Medical Imaging Research Center, KU Leuven, University Hospitals Leuven, 3000, Leuven, Belgium
| | - F Maes
- Department ESAT, Processing Speech and Images (PSI), Medical Imaging Research Center, KU Leuven, University Hospitals Leuven, 3000, Leuven, Belgium
| | - S Nuyts
- Department of Oncology, Radiation-Oncology, University of Leuven, University Hospitals Leuven, 3000, Leuven, KU, Belgium.
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Chen W, Zhang H, Zhang W, Su M, Xie R, Li K, Xia X, Zou C. Development of a contouring guide for three different types of optic chiasm: A practical approach. J Med Imaging Radiat Oncol 2019; 63:657-664. [PMID: 31173469 DOI: 10.1111/1754-9485.12903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 04/23/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Sparing of the organs at risk (OARs) is a crucial task in daily radiotherapy practice. Irradiation of the optic chiasm (OC) results in radiation-induced optic neuropathy (RION). The structure of the OC is complex, and OC morphology can vary in axial images. Therefore, a standard atlas can result in inaccurate descriptions of OC morphology in different patients. The aim of our study was to provide a guide based on computed tomography (CT) for the delineation of different types of OC. METHODS Thirty-six patients were selected to participate in our study. These patients underwent CT analysis of the brain, head and neck regions in a supine position. Axial images 3 mm in thickness were obtained at 3-mm intervals. A magnetic resonance imaging (MRI) study was also performed using the same set-up. The OC was then delineated. The contours were revised by three neuroradiologists and nine radiation oncologists with > 5 years of expertise. RESULTS Three types of OC were distinguished by magnetic resonance (MR). The location and boundaries of normal, prefixed and postfixed chiasms were developed with a CT-based atlas. Discrepancies were observed in the delineation of the prefixed and postfixed OC. CONCLUSIONS Our guide allows improved definitions of the anatomical boundaries for different types of OC. Our experience could provide useful information for radiation oncologists in daily practice.
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Affiliation(s)
- Wenhao Chen
- Department of Chemoradiotherapy Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hui Zhang
- Department of Chemoradiotherapy Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenyi Zhang
- Department of Chemoradiotherapy Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Meng Su
- Department of Chemoradiotherapy Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Raoying Xie
- Department of Chemoradiotherapy Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kejie Li
- Department of Chemoradiotherapy Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaofang Xia
- Department of Chemoradiotherapy Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Changlin Zou
- Department of Chemoradiotherapy Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Braun LH, Braun K, Frey B, Wolpert SM, Löwenheim H, Zips D, Welz S. Unilateral cochlea sparing in locoregionally advanced head and neck cancer: a planning study. Strahlenther Onkol 2018; 194:1124-1131. [PMID: 30109361 DOI: 10.1007/s00066-018-1344-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 07/19/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cochlea sparing can reduce late ototoxicity in head and neck cancer patients treated with cisplatin-based radiochemotherapy. In this situation, a mean cochlear dose (MCD) constraint of 10 Gy has been suggested by others based on the dose-effect relationship of clinical data. We aimed to investigate whether this is feasible for primary and postoperative radiochemotherapy in locoregionally advanced tumors without compromising target coverage. PATIENTS AND METHODS Ten patients treated with definitive and ten patients treated with adjuvant intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy were investigated. The cochleae and a planning risk volume (PRV) with a 3 mm margin were newly delineated, whereas target volumes and other organs at risk were not changed. The initial plan was recalculated with a constraint of 10 Gy (MCD) on the low-risk side. The quality of the resulting plan was evaluated using the difference in the equivalent uniform dose (EUD). RESULTS A unilateral MCD of below 10 Gy could be achieved in every patient. The mean MCD was 6.8 Gy in the adjuvant cohort and 7.6 Gy in the definitive cohort, while the non-spared side showed a mean MCD of 18.7 and 30.3 Gy, respectively. The mean PRV doses were 7.8 and 8.4 Gy for the spared side and 18.5 and 29.8 Gy for the non-spared side, respectively. The mean EUD values of the initial and recalculated plans were identical. Target volume was not compromised. CONCLUSION Unilateral cochlea sparing with an MCD of less than 10 Gy is feasible without compromising the target volume or dose coverage in locoregionally advanced head and neck cancer patients treated with IMRT. A prospective evaluation of the clinical benefit of this approach as well as further investigation of the dose-response relationship for future treatment modification appears promising.
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Affiliation(s)
- L H Braun
- Universitätsklinik für Radioonkologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - K Braun
- Universitätsklinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Tübingen, Elfriede-Aulhorn-Straße 5, 72076, Tübingen, Germany.
| | - B Frey
- Universitätsklinik für Radioonkologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - S M Wolpert
- Universitätsklinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Tübingen, Elfriede-Aulhorn-Straße 5, 72076, Tübingen, Germany
| | - H Löwenheim
- Universitätsklinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Tübingen, Elfriede-Aulhorn-Straße 5, 72076, Tübingen, Germany
| | - D Zips
- Universitätsklinik für Radioonkologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - S Welz
- Universitätsklinik für Radioonkologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
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Di Biase S, Trignani M, Caravatta L, Voicu PI, Di Carlo C, Vinciguerra A, Augurio A, Perrotti F, Panara V, Genovesi D. Development of a contouring guide in three different head set-ups for hippocampal sparing radiotherapy: a practical approach. Radiol Med 2017; 122:683-689. [PMID: 28510808 DOI: 10.1007/s11547-017-0775-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/01/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUNDS Irradiation of the hippocampus plays a role in neurocognitive toxicity. Its delineation is complex and in practice different head position can vary hippocampus morphology on axial images; so atlas in a single standard position can result ineffective to describe different hippocampal morphologies in different head set-up. The purpose of our study was to develop a guide based on magnetic resonance imaging for hippocampus delineation in three different head set-ups. MATERIALS AND METHODS Three patients were selected to elaborate our guide. Patients were submitted to a planning computed tomography of the brain district in different head positions: 1° patient in neutral, 2° patient in over-extended and 3° patient in head hypo-extended position; axial images of 2-mm thickness were obtained. Computed tomography images were fused with diagnostic brain magnetic resonance images; then hippocampus was delineated according to RTOG atlas. Contours were revised by two neuro-radiologists with >5-year expertise in neuroimaging. RESULTS A guide was developed for each of three head positions considered. RTOG atlas provided an easy and reliable guide for hippocampus delineation in neutral position of the head. Discrepancies were observed in cranial and caudal limit in case of head over/hypo-extension, as well as in hippocampal morphology near the encephalic trunk where hippocampus takes an oblong shape in over-extended set-up, and short and stocky in hypo-extension. CONCLUSION Our guide can represent a useful tool for hippocampal delineation in clinical practice and for different anatomic variations due to different head positions. Certainly, it should be validated in practice.
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Affiliation(s)
- Saide Di Biase
- Department of Radiotherapy, "SS Annunziata" Hospital, "G. D'Annunzio" University, Chieti, Italy
| | - Marianna Trignani
- Department of Radiotherapy, "SS Annunziata" Hospital, "G. D'Annunzio" University, Chieti, Italy.
| | - Luciana Caravatta
- Department of Radiotherapy, "SS Annunziata" Hospital, "G. D'Annunzio" University, Chieti, Italy
| | - Paul Ioan Voicu
- Section of Diagnostic Imaging and Therapy, Radiology Division, Department of Neuroscience and Imaging, "SS Annunziata" Hospital, "G. D'Annunzio" University, Chieti, Italy
| | - Clelia Di Carlo
- Department of Radiotherapy, "SS Annunziata" Hospital, "G. D'Annunzio" University, Chieti, Italy
| | - Annamaria Vinciguerra
- Department of Radiotherapy, "SS Annunziata" Hospital, "G. D'Annunzio" University, Chieti, Italy
| | - Antonietta Augurio
- Department of Radiotherapy, "SS Annunziata" Hospital, "G. D'Annunzio" University, Chieti, Italy
| | - Francesca Perrotti
- Department of Radiotherapy, "SS Annunziata" Hospital, "G. D'Annunzio" University, Chieti, Italy
| | - Valentina Panara
- Section of Diagnostic Imaging and Therapy, Radiology Division, Department of Neuroscience and Imaging, "SS Annunziata" Hospital, "G. D'Annunzio" University, Chieti, Italy
| | - Domenico Genovesi
- Department of Radiotherapy, "SS Annunziata" Hospital, "G. D'Annunzio" University, Chieti, Italy
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Maingon P. Argumentaire clinique pour la radiothérapie guidée par imagerie par résonance magnétique. Cancer Radiother 2016; 20:558-63. [DOI: 10.1016/j.canrad.2016.07.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 11/24/2022]
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Boisselier P, Racadot S, Thariat J, Graff P, Pointreau Y. Radiothérapie conformationnelle avec modulation d’intensité des cancers des voies aérodigestives supérieures. Dose de tolérance des tissus sains : moelle épinière et plexus brachial. Cancer Radiother 2016; 20:459-66. [DOI: 10.1016/j.canrad.2016.08.124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/03/2016] [Indexed: 12/25/2022]
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Guimas V, Thariat J, Graff-Cailleau P, Boisselier P, Pointreau Y, Pommier P, Montbarbon X, Laude C, Racadot S. Radiothérapie conformationnelle avec modulation d’intensité des cancers des voies aérodigestives supérieures, dose de tolérance des tissus sains : appareil cochléovestibulaire et tronc cérébral. Cancer Radiother 2016; 20:475-83. [DOI: 10.1016/j.canrad.2016.07.077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 07/09/2016] [Accepted: 07/11/2016] [Indexed: 12/25/2022]
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Antoni D, Noël G. Quelles contraintes pour quels organes à risque pour les radiothérapies chez l’adulte ? Cancer Radiother 2015; 19:479-83. [DOI: 10.1016/j.canrad.2015.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 05/20/2015] [Accepted: 05/21/2015] [Indexed: 11/28/2022]
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