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Interobserver Variability in Target Definition for Hepatocellular Carcinoma With and Without Portal Vein Thrombus: Radiation Therapy Oncology Group Consensus Guidelines

Authors
 Theodore S. Hong  ;  Walter R. Bosch  ;  Sunil Krishnan  ;  Tae K. Kim  ;  Harvey J. Mamon  ;  Paul Shyn  ;  Edgar Ben-Josef  ;  Jinsil Seong  ;  Michael G. Haddock  ;  Jason C. Cheng  ;  Mary U. Feng  ;  Kevin L. Stephans  ;  David Roberge  ;  Christopher Crane  ;  Laura A. Dawson 
Citation
 INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, Vol.89(4) : 804-813, 2014 
Journal Title
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
ISSN
 0360-3016 
Issue Date
2014
MeSH
Aged ; Algorithms ; Carcinoma, Hepatocellular/blood supply ; Carcinoma, Hepatocellular/diagnosis* ; Carcinoma, Hepatocellular/diagnostic imaging ; Consensus* ; Female ; Humans ; Liver Neoplasms/blood supply ; Liver Neoplasms/diagnosis* ; Liver Neoplasms/diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Multimodal Imaging/methods ; Observer Variation ; Portal Vein*/diagnostic imaging ; Reproducibility of Results ; Tomography, X-Ray Computed ; Tumor Burden ; Uncertainty ; Venous Thrombosis/diagnosis* ; Venous Thrombosis/diagnostic imaging
Abstract
PURPOSE: Defining hepatocellular carcinoma (HCC) gross tumor volume (GTV) requires multimodal imaging, acquired in different perfusion phases. The purposes of this study were to evaluate the variability in contouring and to establish guidelines and educational recommendations for reproducible HCC contouring for treatment planning. METHODS AND MATERIALS:Anonymous, multiphasic planning computed tomography scans obtained from 3 patients with HCC were identified and distributed to a panel of 11 gastrointestinal radiation oncologists. Panelists were asked the number of HCC cases they treated in the past year. Case 1 had no vascular involvement, case 2 had extensive portal vein involvement, and case 3 had minor branched portal vein involvement. The agreement between the contoured total GTVs (primary + vascular GTV) was assessed using the generalized kappa statistic. Agreement interpretation was evaluated using Landis and Koch's interpretation of strength of agreement. The S95 contour, defined using the simultaneous truth and performance level estimation (STAPLE) algorithm consensus at the 95% confidence level, was created for each case. RESULTS:Of the 11 panelists, 3 had treated >25 cases in the past year, 2 had treated 10 to 25 cases, 2 had treated 5 to 10 cases, 2 had treated 1 to 5 cases, 1 had treated 0 cases, and 1 did not respond. Near perfect agreement was seen for case 1, and substantial agreement was seen for cases 2 and 3. For case 2, there was significant heterogeneity in the volume identified as tumor thrombus (range 0.58-40.45 cc). For case 3, 2 panelists did not include the branched portal vein thrombus, and 7 panelists contoured thrombus separately from the primary tumor, also showing significant heterogeneity in volume of tumor thrombus (range 4.52-34.27 cc). CONCLUSIONS:In a group of experts, excellent agreement was seen in contouring total GTV. Heterogeneity exists in the definition of portal vein thrombus that may impact treatment planning, especially if differential dosing is contemplated. Guidelines for HCC GTV contouring are recommended.
Full Text
http://www.sciencedirect.com/science/article/pii/S0360301614003988
DOI
10.1016/j.ijrobp.2014.03.041
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Seong, Jin Sil(성진실) ORCID logo https://orcid.org/0000-0003-1794-5951
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/99308
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