Target volume delineation for partial breast radiotherapy planning: Clinical characteristics associated with low interobserver concordance

被引:129
作者
Petersen, Ross P.
Truong, Pauline T.
Kader, Hosam A.
Berthelet, Eric
Lee, Junella C.
Hilts, Michelle L.
Kader, Adam S.
Beckham, Wayne A.
Olivotto, Ivo A.
机构
[1] Vancouver Isl Ctr, British Columbia Canc Agcy, Radiat Therapy Program, Victoria, BC V8R 6V5, Canada
[2] Univ British Columbia, Victoria, BC, Canada
[3] Univ Victoria, Victoria, BC, Canada
来源
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS | 2007年 / 69卷 / 01期
关键词
breast cancer; partial breast radiotherapy; target volume; interobserver variability; conformity index;
D O I
10.1016/j.ijrobp.2007.01.070
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: To examine variability in target volume delineation for partial breast radiotherapy planning and evaluate characteristics associated with low interobserver concordance. Methods and Materials: Thirty patients who underwent planning CT for adjuvant breast radiotherapy formed the study cohort. Using a standardized scale to score seroma clarity and consensus contouring guidelines, three radiation oncologists independently graded seroma clarity and delineated seroma volumes for each case. Seroma geometric center coordinates, maximum diameters in three axes, and volumes were recorded. Conformity index (CI), the ratio of overlapping volume and encompassing delineated volume, was calculated for each case. Cases with CI <= 0.50 were analyzed to identify features associated with low concordance. Results: The median time from surgery to CT was 42.5 days. For geometric center coordinates, variations from the mean were 0.5-1.1 mm and standard deviations (SDs) were 0.5-1.8 mm. For maximum seroma dimensions, variations from the mean and SDs were predominantly <5 mm, with the largest SDs observed in the medial-lateral axis. The mean CI was 0.61 (range, 0.27-0.84). Five cases had CI <= 0.50. Conformity index was significantly associated with seroma clarity (p < 0.001) and seroma volume (p < 0.002). Features associated with reduced concordance included tissue stranding from the surgical cavity, proximity to muscle, dense breast parenchyma, and benign calcifications that may be mistaken for surgical clips. Conclusion: Variability in seroma contouring occurred in three dimensions, with the largest variations in the medial-lateral axis. Awareness of clinical features associated with reduced concordance may be applied toward training staff and refining contouring guidelines for partial breast radiotherapy trials. (c) 2007 Elsevier Inc.
引用
收藏
页码:41 / 48
页数:8
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