Inter-clinician delineation variation for a new highly-conformal flank target volume in children with renal tumors: A SIOP-Renal Tumor Study Group international multicenter exercise
Cameron, A. L.
Kroon, P. S.
Hoeben, B. A. W.
van Rossum, P. S. N.
van Grotel, M.
van den Heuvel-Eibrink, M. M.
Janssens, G. O.
AffiliationPrincess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
MetadataShow full item record
AbstractBackground and purpose: Recently, the SIOP-RTSG developed a highly-conformal flank target volume definition for children with renal tumors. The aims of this study were to evaluate the inter-clinician delineation variation of this new target volume definition in an international multicenter setting and to explore the necessity of quality assurance. Materials and methods: Six pediatric renal cancer cases were transferred to ten radiation oncologists from seven European countries ('participants'). These participants delineated the pre- and postoperative Gross Tumor Volume (GTVpre/post), and Clinical Target Volume (CTV) during two test phases (case 1-2 and 3-4), followed by guideline refinement and a quality assurance phase (case 5-6). Reference target volumes (TVref) were established by three experienced radiation oncologists. The Dice Similarity Coefficient between the reference and participants (DSCref/part) was calculated per case. Delineations of case 5-6 were graded by four independent reviewers as 'per protocol' (0-4 mm), 'minor deviation' (5-9 mm) or 'major deviation' (≥10 mm) from the delineation guideline using 18 standardized criteria. Also, a major deviation resulting in underestimation of the CTVref was regarded as an unacceptable variation. Results: A total of 57/60 delineation sets were completed. The median DSCref/part for the CTV was 0.55 without improvement after sequential cases (case 3-4 vs. case 5-6: p = 0.15). For case 5-6, a major deviation was found for 5/18, 12/17, 18/18 and 4/9 collected delineations of the GTVpre, GTVpost, CTV-T and CTV-N, respectively. An unacceptable variation from the CTVref was found for 7/9 participants for case 5 and 6/9 participants for case 6. Conclusion: This international multicenter delineation exercise demonstrates that the new consensus for highly-conformal postoperative flank target volume delineation leads to geometrical variation among participants. Moreover, standardized review showed an unacceptable delineation variation in the majority of the participants. These findings strongly suggest the need for additional training and centralized pre-treatment review when this target volume delineation approach is implemented on a larger scale.
CitationMul J, Melchior P, Seravalli E, Saunders D, Bolle S, Cameron AL, et al. Inter-clinician delineation variation for a new highly-conformal flank target volume in children with renal tumors: A SIOP-Renal Tumor Study Group international multicenter exercise. Clin Transl Radiat Oncol. 2021;28:39-47.
JournalClinical and Translational Radiation Oncology
- Estimated clinical benefit of combining highly conformal target volumes with Volumetric-Modulated Arc Therapy (VMAT) versus conventional flank irradiation in pediatric renal tumors.
- Authors: Mul J, Seravalli E, Bosman ME, van de Ven CP, Littooij AS, van Grotel M, van den Heuvel-Eibrink MM, Janssens GO
- Issue date: 2021 Jul
- The SIOP-Renal Tumour Study Group consensus statement on flank target volume delineation for highly conformal radiotherapy.
- Authors: Janssens GO, Melchior P, Mul J, Saunders D, Bolle S, Cameron AL, Claude L, Gurtner K, van de Ven KP, van Grotel M, Harrabi S, Lassen-Ramshad Y, Lavan N, Magelssen H, Muracciole X, Boterberg T, Mandeville H, Godzinski J, Graf N, van den Heuvel-Eibrink MM, Rübe C
- Issue date: 2020 Nov
- Variability of clinical target volume delineation for rectal cancer patients planned for neoadjuvant radiotherapy with the aid of the platform Anatom-e.
- Authors: 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
- Issue date: 2018 Jun
- Quantitative assessment of inter-clinician variability of target volume delineation for medulloblastoma: quality assurance for the SIOP PNET 4 trial protocol.
- Authors: Coles CE, Hoole AC, Harden SV, Burnet NG, Twyman N, Taylor RE, Kortmann RD, Williams MV
- Issue date: 2003 Nov
- Improving the accuracy and consistency of clinical target volume delineation for rectal cancer by an education program.
- Authors: Zhang YZ, Zhu XG, Song MX, Yao KN, Li S, Geng JH, Wang HZ, Li YH, Cai Y, Wang WH
- Issue date: 2022 May 15