International assessment of interobserver reproducibility of flap delineation in head and neck carcinoma
Yom, S. S.
Marcy, P. Y.
AffiliationDepartment of Radiation Oncology, Institut Curie, Paris - Orsay, France. Laboratoire d'Imagerie Translationnelle en Oncologie (LITO), U1288 Université Paris Saclay/Inserm/Institut Curie, Orsay, France. Department of Radiation Oncology, University Hospital of Amiens, Amiens, France. Department of Radiation Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom. Department of Radiation Oncology, University of California San Francisco, USA. Department of Radiation Oncology, Polyclinique Marzet, Pau, France. Department of Radiation Oncology, Centre Léon Bérard Lyon, France. Department of Radiation Oncology, Centre Jean Bernard, Le Mans, France. Department of Radiation Oncology, GenesisCare. St Vincent's Hospital, Fitzroy, Australia. Department of Radiation Oncology, Aarhus University Hospital, Aarhus, Danemark. Department of Radiation Oncology, Princess Alexandra Hospital Southside Clinical Unit, Australia. Department of Radiation Oncology, Centre François Baclesse, Caen, France. Department of Head and Neck Surgery, Centre François Baclesse, Caen, France. Department or Radiology, Polyclinique les Fleurs, Ollioules, France. Department of Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France. Department of Radiation Oncology, University Hospital of Vaudois, Lausanne, Swiss. Department of Statistics, Lorraine Cancer Institute, Vandoeuvre-lès-Nancy, France. Laboratoire de physique Corpusculaire IN2P3/ENSICAEN/CNRS UMR 6534 - Normandie Université, Caen, France.
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AbstractBackground: Several reports have suggested that radiotherapy after reconstructive surgery for head and neck cancer (HNC), could have deleterious effects on the flaps with respect to functional outcomes. To predict and prevent toxicities, flap delineation should be accurate and reproducible. The objective of the present study was to evaluate the interobserver variability of frequent types of flaps used in HNC, based on the recent GORTEC atlas. Materials and methods: Each member of an international working group (WG) consisting of 14 experts delineated the flaps on a CT set from six patients. Each patient had one of the five most commonly used flaps in HNC: a regional pedicled pectoralis major myocutaneous flap, a local pedicled rotational soft tissue facial artery musculo-mucosal (FAMM) (2 patients), a fasciocutaneous radial forearm free flap, a soft tissue anterolateral thigh (ALT) free flap, or a fibular free flap. The WG’s contours were compared to a reference contour, validated by a surgeon and a radiologist specializing in HNC. Contours were considered as reproducible if the median Dice Similarity Coefficient (DSC) was > 0.7. Results: The median volumes of the six flaps delineated by the WG were close to the reference contour value, with approximately 50 cc for the pectoral, fibula, and ALT flaps, 20 cc for the radial forearm, and up to 10 cc for the FAMM. The volumetric ratio was thus close to the optimal value of 100% for all flaps. The median DSC obtained by the WG compared to the reference for the pectoralis flap, the FAMM, the radial forearm flap, ALT flap, and the fibular flap were 0.82, 0.40, 0.76, 0.81, and 0.76, respectively. Conclusions: This study showed that the delineation of four main flaps used for HNC was reproducible. The delineation of the FAMM, however, requires close cooperation between radiologist, surgeon and radiation oncologist because of the poor visibility of this flap on CT and its small size.
CitationBeddok A, Guzene L, Coutte A, Thomson D, Yom SS, Calugaru V, et al. International assessment of interobserver reproducibility of flap delineation in head and neck carcinoma [Internet]. Acta Oncologica. Informa UK Limited; 2022. p. 1–8.
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