TY - JOUR
T1 - Inter-clinician delineation variation for a new highly-conformal flank target volume in children with renal tumors
T2 - A SIOP-Renal Tumor Study Group international multicenter exercise
AU - Mul, Joeri
AU - Melchior, Patrick
AU - Seravalli, Enrica
AU - Saunders, Daniel
AU - Bolle, Stephanie
AU - Cameron, Alison L.
AU - Gurtner, Kristin
AU - Harrabi, Semi
AU - Lassen-Ramshad, Yasmin
AU - Lavan, Naomi
AU - Magelssen, Henriette
AU - Mandeville, Henry
AU - Boterberg, Tom
AU - Kroon, Petra S.
AU - Kotte, Alexis N.T.J.
AU - Hoeben, Bianca A.W.
AU - van Rossum, Peter S.N.
AU - van Grotel, Martine
AU - Graf, Norbert
AU - van den Heuvel-Eibrink, Marry M.
AU - Rübe, Christian
AU - Janssens, Geert O.
N1 - Publisher Copyright:
© 2021 The Author(s)
PY - 2021/5
Y1 - 2021/5
N2 - Background 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.
AB - Background 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.
KW - Flank target volume
KW - Highly-conformal radiotherapy
KW - Inter-clinician variation
KW - Pediatric renal tumors
KW - Quality assurance
KW - Wilms tumor
UR - http://www.scopus.com/inward/record.url?scp=85102571616&partnerID=8YFLogxK
U2 - 10.1016/j.ctro.2021.03.001
DO - 10.1016/j.ctro.2021.03.001
M3 - Article
C2 - 33796796
AN - SCOPUS:85102571616
SN - 2405-6308
VL - 28
SP - 39
EP - 47
JO - Clinical and translational radiation oncology
JF - Clinical and translational radiation oncology
ER -