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Pasquier D, Darloy F, Dewas S, Gras L, Maillard S, Rhliouch H, Tokarski M, Wagner JP, Degrendel-Courtecuisse AC, Dufour C, Fares M, Gilbeau L, Olszyk O, Castelain B, Lartigau É. Harmonization of practices between radiotherapy centres in the Nord and Pas-de-Calais regions (France): A three-year evaluation. Cancer Radiother 2019; 23:10-16. [PMID: 30639377 DOI: 10.1016/j.canrad.2018.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/18/2018] [Accepted: 03/05/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE The delineation of volumes of interest can be a source of significant interobserver variability. The purpose of this study was to improve the homogeneity of delineation between oncologist-radiotherapists in the territorial departments of Nord and Pas-de-Calais (France) through discussions of clinical cases and the adoption of common published reference documents. MATERIALS AND METHODS All eleven radiotherapy centres in the Nord and Pas-de-Calais departments of France participated. The localizations assessed to date included prostate, head and neck, breast and brain cancers. For each localization, the junior or senior physician(s) in charge of pathology delineated the volumes of interest according to their usual practices. Validated indices, including the Dice similarity coefficient, were used to quantify the delineation differences. The anonymized results were presented at two to three annual meetings. A second delineation of the clinical cases was then carried out to quantify homogenization. An evaluation of dosimetry practices was also conducted for prostate cancer. Wilcoxon assay matched data were used. RESULTS Our work showed either satisfactory delineation concordance after the initial assessment or improved delineation concordance. For prostate cancer, the Dice similarity coefficient values were greater than 0.6 initially in two of the three clinical cases. For head and neck cancers, a statistically significant improvement was observed for only one of the clinical target volumes. More than half of the Dice similarity coefficient values were greater than 0.6 in the first comparison. The study of clinical cases of breast cancer allowed a homogenization of the delineation of five of the six lymph node clinical target volumes. The dosimetry study of prostate cancer allowed for a homogenization of practices. CONCLUSION This work makes it possible to harmonize the delineation practices around validated standards. An extension to the entire Hauts-de-France region is planned.
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Affiliation(s)
- D Pasquier
- Academic Radiation Oncology Department, centre Oscar-Lambret, Lille University, 3, rue Combemale, 59020 Lille cedex, France; Centre de recherche en informatique, signal et automatique de Lille (Cristal), CNRS UMR 9189, Cité scientifique, CS 20048, 59651 Villeneuve d'Ascq cedex, France.
| | - F Darloy
- Centre Léonard-de-Vinci, route de Cambrai, 59187 Dechy, France
| | - S Dewas
- Centre Bourgogne, clinique du Bois, 252, avenue Marx-Dormoy, 59000 Lille, France
| | - L Gras
- Centre Léonard-de-Vinci, route de Cambrai, 59187 Dechy, France
| | - S Maillard
- Centre Bourgogne, clinique du Bois, 252, avenue Marx-Dormoy, 59000 Lille, France
| | - H Rhliouch
- Centre Marie-Curie, 4, rue du Docteur-Forgeois, 62000 Arras, France
| | - M Tokarski
- Centre de cancérologie de l'Artois, 99, route de la Bassée, 62300 Lens, France
| | - J P Wagner
- Institut Andrée-Dutreix, 891, avenue de Rosendaël-Jacques-Collache, 59240 Dunkerque, France
| | | | - C Dufour
- Centre de cancérologie Les Dentellières, 8, avenue Vauban, 59300 Valenciennes, France
| | - M Fares
- Centre Pierre-Curie, 7, rue Delbecque, 62660 Beuvry, France
| | - L Gilbeau
- Centre Gray, 6, allée de la Polyclinique, 59600 Maubeuge, France
| | - O Olszyk
- Centre Galilée, rue de la Louvière, 59000 Lille, France
| | - B Castelain
- Academic Radiation Oncology Department, centre Oscar-Lambret, Lille University, 3, rue Combemale, 59020 Lille cedex, France
| | - É Lartigau
- Academic Radiation Oncology Department, centre Oscar-Lambret, Lille University, 3, rue Combemale, 59020 Lille cedex, France; Centre de recherche en informatique, signal et automatique de Lille (Cristal), CNRS UMR 9189, Cité scientifique, CS 20048, 59651 Villeneuve d'Ascq cedex, France
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Dewas S, Rhliouch H, Wagner JP, Auliard A, Gilbeau L, Degrendel AC, Gras L, Olszyk O, Tokarski M, Pasquier D. Harmonisation de la délinéation des volumes d’intérêt entre les centres de radiothérapie de la région Nord-Pas-de-Calais. Cancer Radiother 2017. [DOI: 10.1016/j.canrad.2017.08.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pasquier D, Boutaud de la Combe-Chossiere L, Carlier D, Darloy F, Degrendel-Courtecuisse AC, Dufour C, Fares M, Gilbeau L, Liem X, Martin P, Meyer P, Minne JF, Olszyk O, Rhliouch H, Tokarski M, Viot C, Castelain B, Lartigau E. Harmonization of the Volume of Interest Delineation among All Eleven Radiotherapy Centers in the North of France. PLoS One 2016; 11:e0150917. [PMID: 26987121 PMCID: PMC4795685 DOI: 10.1371/journal.pone.0150917] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 02/21/2016] [Indexed: 11/19/2022] Open
Abstract
Background Inter-observer delineation variation has been detailed for many years in almost every tumor location. Inadequate delineation can impair the chance of cure and/or increase toxicity. The aim of our original work was to prospectively improve the homogeneity of delineation among all of the senior radiation oncologists in the Nord-Pas de Calais region, irrespective of the conditions of practice. Methods All 11 centers were involved. The first studied cancer was prostate cancer. Three clinical cases were studied: a low-risk prostate cancer case (case 1), a high-risk prostate cancer case (pelvic nodes, case 2) and a case of post-operative biochemical elevated PSA (case 3). All of the involved physicians delineated characteristically the clinical target volume (CTV) and organs at risk. The volumes were compared using validated indexes: the volume ratio (VR), common and additional volumes (CV and AV), volume overlap (VO) and Dice similarity coefficient (DSC). A second delineation of the same three cases was performed after discussion of the slice results and the choice of shared guidelines to evaluate homogenization. A comparative analysis of the indexes before and after discussion was conducted using the Wilcoxon test for paired samples. A p-value less than 0.05 was considered to indicate statistical significance. Results The indexes were not improved in case 1, for which the inter-observer agreement was considered good after the first comparison (DSC = 0.83±0.06). In case 2, the second comparison showed homogenization of the CTV delineation with a significant improvement in CV (81.4±11.7 vs. 88.6±10.26, respectively, p = 0.048), VO (0.41±0.09 vs. 0.47±0.07, respectively; p = 0.009) and DSC (0.58±0.09 vs. 0.63±0.07, respectively; p = 0.0098). In case 3, VR and AV were significantly improved: VR: 1.71(±0.6) vs. 1.34(±0.46), respectively, p = 0.0034; AV: 46.58(±14.50) vs. 38.08(±15.10), respectively, p = 0.0024. DSC was not improved, but it was already superior to 0.6 in the first comparison. Conclusion Our prospective work showed that a collaborative discussion about clinical cases and the choice of shared guidelines within an established framework improved the homogeneity of CTV delineation among the senior radiation oncologists in our region.
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Affiliation(s)
- David Pasquier
- Academic Radiation Oncology Department, Centre Oscar Lambret, Lille University, Lille, France
- CRISTAL, UMR CNRS 9189, Lille, France
- * E-mail:
| | | | | | | | | | - Chantal Dufour
- Centre de Cancérologie Les Dentellières, Valenciennes, France
| | | | | | - Xavier Liem
- Academic Radiation Oncology Department, Centre Oscar Lambret, Lille University, Lille, France
| | | | | | | | | | | | | | - Chloé Viot
- Réseau Onco Nord Pas de Calais, Loos, France
| | - Bernard Castelain
- Academic Radiation Oncology Department, Centre Oscar Lambret, Lille University, Lille, France
| | - Eric Lartigau
- Academic Radiation Oncology Department, Centre Oscar Lambret, Lille University, Lille, France
- CRISTAL, UMR CNRS 9189, Lille, France
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Ozsahin M, Gruber G, Olszyk O, Karakoyun-Celik O, Pehlivan B, Azria D, Roelandts M, Kaanders JHAM, Cengiz M, Krengli M, Matzinger O, Zouhair A. Outcome and prognostic factors in olfactory neuroblastoma: a rare cancer network study. Int J Radiat Oncol Biol Phys 2010; 78:992-7. [PMID: 20231062 DOI: 10.1016/j.ijrobp.2009.09.019] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 08/11/2009] [Accepted: 09/09/2009] [Indexed: 12/11/2022]
Abstract
PURPOSE To assess the outcome in patients with olfactory neuroblastoma (ONB). METHODS AND MATERIALS Seventy-seven patients treated for nonmetastatic ONB between 1971 and 2004 were included. According to Kadish classification, there were 11 patients with Stage A, 29 with Stage B, and 37 with Stage C. T-classification included 9 patients with T1, 26 with T2, 16 with T3, 15 with T4a, and 11 with T4b tumors. Sixty-eight patients presented with N0 (88%) disease. RESULTS Most of the patients (n = 56, 73%) benefited from surgery (S), and total excision was possible in 44 patients (R0 in 32, R1 in 13, R2 in 11). All but five patients benefited from RT, and chemotherapy was given in 21 (27%). Median follow-up period was 72 months (range, 6-315). The 5-year overall survival (OS), disease-free survival (DFS), locoregional control, and local control were 64%, 57%, 62%, and 70%, respectively. In univariate analyses, favorable factors were Kadish A or B disease, T1-T3 tumors, no nodal involvement, curative surgery, R0/R1 resection, and RT-dose 54 Gy or higher. Multivariate analysis revealed that the best independent factors predicting the outcome were T1-T3, N0, R0/R1 resection, and total RT dose (54 Gy or higher). CONCLUSION In this multicenter retrospective study, patients with ONB treated with R0 or R1 surgical resection followed by at least 54-Gy postoperative RT had the best outcome. Novel strategies including concomitant chemotherapy and/or higher dose RT should be prospectively investigated in this rare disease for which local failure remains a problem.
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Affiliation(s)
- Mahmut Ozsahin
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
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Ozsahin M, Olszyk O, Karakoyun-Celik O, Pehlivan B, Azria D, Roelandts M, Kaanders M, Cengiz M, Krengli M, Zouhair A. Outcome and Prognostic Factors in Olfactory Neuroblastoma: A Multicenter Rare Cancer Network Study. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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