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Franco P, Arcadipane F, Trino E, Gallio E, Martini S, Iorio GC, Piva C, Moretto F, Ruo Redda MG, Verna R, Tseroni V, Bona C, Pozzi G, Fiandra C, Ragona R, Bertetto O, Ricardi U. Variability of clinical target volume delineation for rectal cancer patients planned for neoadjuvant radiotherapy with the aid of the platform Anatom-e. Clin Transl Radiat Oncol 2018; 11:33-39. [PMID: 29928706 PMCID: PMC6008279 DOI: 10.1016/j.ctro.2018.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 06/05/2018] [Accepted: 06/08/2018] [Indexed: 02/08/2023] Open
Abstract
Objective Delineation of treatment volumes is a major source of uncertainties in radiotherapy (RT). This is also true for rectal cancer patients undergoing neoadjuvant RT, with a potential impact on treatment quality. We investigated the role of the digital platform Anatom-e (Anatom-e Information Sytems Ltd., Houston, Texas) in increasing the compliance to follow a specific treatment protocol in a multicentric setting. Materials and methods Two clinical cases of locally advanced rectal cancer were chosen. Participants were instructed to follow the 2009 Radiation Therapy Oncology Group consensus atlas and asked to manually segment clinical target volumes (CTVs), for both patient 1 and 2, on day 1 with and without the use of Anatom-e. After one week (day 2), the same radiation oncologist contoured again, with and without Anatom-e, the same CT series. Intraobserver (Intra-OV) and interobserver (Inter-OV) variability were evaluated with the Dice similarity coefficient (DSC), the Hausdorff distance (HD) and mean distance to agreement (MDA). Results For clinical case 1, no significant difference was found for Intra-OV and Inter-OV. For clinical case 2, no significant difference was found for Intra-OV but a statistically significant difference was found for Inter-OV in DSC when using or not the platform. Mean DCS was 0.65 (SD: ±0.64; range: 0.58-0.79) for day 1 vs reference volume without Anatom-e and 0.72 (SD: ±0.39; range: 0.67-0.77) (p = 0.03) with it. Mean MDA was lower with Anatom-e (3.61; SD: ±1.33; range: 2.85-4.78) than without (4.14; SD: ±2.97; range: 2.18-5.21), with no statistical significance (p = 0.21) The use of Anatom-e decreased the SD from 2.97 to 1.33. Mean HD was lower with Anatom-e (26.06; SD: ±2.05; range: 24.08-32.62), with no statistical significance (p = 0.14) compared to that without (31.39; SD: ±1.31; range: 26.14-48.72). Conclusions The use of Anatom-e decreased the Inter-OV in the CTV delineation process for locally advanced rectal cancer with complex disease presentation planned for neoadjuvant RT. This system may be potentially helpful in increasing the compliance to follow shared guidelines and protocols.
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Key Words
- AJCC/UICC, American Joint Committee on Cancer/Union Internationale Contre le Cancer
- CHT, chemotherapy
- CT, computed tomography
- CTV, clinical target volume
- Contouring
- DSC, Dice similarity coefficient
- GTV, gross tumor volume
- HD, Hausdorff distance
- Inter-OV, inter-observer variability
- Interobserver variability
- Intra-OV, intra-observer variability
- MDA, mean distance to agreement
- MR, magnetic resonance imaging
- Neoadjuvant radiotherapy
- OARs, organs at risk
- RT, radiotherapy
- RTOG, Radiation Therapy Oncology Group
- Rectal cancer
- Ros, radiation oncologists
- SD, standard deviation
- SWOG, Radiation Committee of the Southwest Oncology Group
- Target volume delineation
- VMAT, volumetric modulated arc therapy
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Affiliation(s)
- Pierfrancesco Franco
- Department of Oncology, Radiation Oncology, University of Turin, AOU Citta' della salute e della Scienza, Turin, Italy
| | - Francesca Arcadipane
- Department of Oncology, Radiation Oncology, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Elisabetta Trino
- Department of Oncology, Radiation Oncology, University of Turin, AOU Citta' della salute e della Scienza, Turin, Italy
| | - Elena Gallio
- Department of Medical Physics, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Stefania Martini
- Department of Oncology, Radiation Oncology, University of Turin, AOU Citta' della salute e della Scienza, Turin, Italy
| | - Giuseppe Carlo Iorio
- Department of Oncology, Radiation Oncology, University of Turin, AOU Citta' della salute e della Scienza, Turin, Italy
| | - Cristina Piva
- Department of Radiation Oncology, Ivrea Community Hospital, Ivrea, Italy
| | - Francesco Moretto
- Department of Radiation Oncology, 'Cardinal Massaia' Community Hospital, Asti, Italy
| | - Maria Grazia Ruo Redda
- Department of Oncology, Radiation Oncology, University of Turin, AO Ordine Mauriziano, Turin, Italy
| | - Roberta Verna
- Department of Radiation Oncology, AOU San Luigi Gonzaga, Orbassano (TO), Italy
| | - Vassiliki Tseroni
- Department of Oncology, Radiation Oncology, AOU Citta' della Salute e della Scienza, Presidio San Giovanni Antica Sede, Turin, Italy
| | - Cristina Bona
- Department of Radiation Oncology, ASL Verbano Cusio Ossola, Verbania, Italy
| | - Gabriele Pozzi
- Department of Radiation Oncology, AO 'SS Antonio e Biagio e Cesare Arrigo', Alessandria, Italy
| | - Christian Fiandra
- Department of Oncology, Radiation Oncology, University of Turin, AOU Citta' della salute e della Scienza, Turin, Italy
| | - Riccardo Ragona
- Department of Oncology, Radiation Oncology, University of Turin, AOU Citta' della salute e della Scienza, Turin, Italy
| | | | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin, AOU Citta' della salute e della Scienza, Turin, Italy
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