Delineation uncertainties of tumour volumes on MRI of head and neck cancer patients

Ruta Zukauskaite; Christopher N. Rumley; Christian R. Hansen; Michael G. Jameson; Yuvnik Trada; Jørgen Johansen; Niels Gyldenkerne; Jesper G. Eriksen; Farhannah Aly; Rasmus L. Christensen; Mark Lee; Carsten Brink; Lois Holloway

doi:10.1016/j.ctro.2022.08.005

Delineation uncertainties of tumour volumes on MRI of head and neck cancer patients

Ruta Zukauskaite^*, Christopher N. Rumley, Christian R. Hansen, Michael G. Jameson, Yuvnik Trada, Jørgen Johansen, Niels Gyldenkerne, Jesper G. Eriksen, Farhannah Aly, Rasmus L. Christensen, Mark Lee, Carsten Brink, Lois Holloway

^*Corresponding author af dette arbejde

Institut for Klinisk Medicin - Kræftafdelingen

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

Abstract

Background: During the last decade, radiotherapy using MR Linac has gone from research to clinical implementation for different cancer locations. For head and neck cancer (HNC), target delineation based only on MR images is not yet standard, and the utilisation of MRI instead of PET/CT in radiotherapy planning is not well established. We aimed to analyse the inter-observer variation (IOV) in delineating GTV (gross tumour volume) on MR images only for patients with HNC. Material/methods: 32 HNC patients from two independent departments were included. Four clinical oncologists from Denmark and four radiation oncologists from Australia had independently contoured primary tumour GTVs (GTV-T) and nodal GTVs (GTV-N) on T2-weighted MR images obtained at the time of treatment planning. Observers were provided with sets of images, delineation guidelines and patient synopsis. Simultaneous truth and performance level estimation (STAPLE) reference volumes were generated for each structure using all observer contours. The IOV was assessed using the DICE Similarity Coefficient (DSC) and mean absolute surface distance (MASD). Results: 32 GTV-Ts and 68 GTV-Ns were contoured per observer. The median MASD for GTV-Ts and GTV-Ns across all patients was 0.17 cm (range 0.08–0.39 cm) and 0.07 cm (range 0.04–0.33 cm), respectively. Median DSC relative to a STAPLE volume for GTV-Ts and GTV-Ns across all patients were 0.73 and 0.76, respectively. A significant correlation was seen between median DSCs and median volumes of GTV-Ts (Spearman correlation coefficient 0.76, p < 0.001) and of GTV-Ns (Spearman correlation coefficient 0.55, p < 0.001). Conclusion: Contouring GTVs in patients with HNC on MRI showed that the median IOV for GTV-T and GTV-N was below 2 mm, based on observes from two separate radiation departments. However, there are still specific regions in tumours that are difficult to resolve as either malignant tissue or oedema that potentially could be improved by further training in MR-only delineation.

Originalsprog	Engelsk
Tidsskrift	Clinical and Translational Radiation Oncology
Vol/bind	36
Sider (fra-til)	121-126
Antal sider	6
ISSN	2405-6308
DOI	https://doi.org/10.1016/j.ctro.2022.08.005
Status	Udgivet - sep. 2022

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10.1016/j.ctro.2022.08.005Licens: CC BY-NC-ND

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Zukauskaite, R., Rumley, C. N., Hansen, C. R., Jameson, M. G., Trada, Y., Johansen, J., Gyldenkerne, N., Eriksen, J. G., Aly, F., Christensen, R. L., Lee, M., Brink, C., & Holloway, L. (2022). Delineation uncertainties of tumour volumes on MRI of head and neck cancer patients. Clinical and Translational Radiation Oncology, 36, 121-126. https://doi.org/10.1016/j.ctro.2022.08.005

@article{cefaf64e6f48473abf6c43a019aa8253,

title = "Delineation uncertainties of tumour volumes on MRI of head and neck cancer patients",

abstract = "Background: During the last decade, radiotherapy using MR Linac has gone from research to clinical implementation for different cancer locations. For head and neck cancer (HNC), target delineation based only on MR images is not yet standard, and the utilisation of MRI instead of PET/CT in radiotherapy planning is not well established. We aimed to analyse the inter-observer variation (IOV) in delineating GTV (gross tumour volume) on MR images only for patients with HNC. Material/methods: 32 HNC patients from two independent departments were included. Four clinical oncologists from Denmark and four radiation oncologists from Australia had independently contoured primary tumour GTVs (GTV-T) and nodal GTVs (GTV-N) on T2-weighted MR images obtained at the time of treatment planning. Observers were provided with sets of images, delineation guidelines and patient synopsis. Simultaneous truth and performance level estimation (STAPLE) reference volumes were generated for each structure using all observer contours. The IOV was assessed using the DICE Similarity Coefficient (DSC) and mean absolute surface distance (MASD). Results: 32 GTV-Ts and 68 GTV-Ns were contoured per observer. The median MASD for GTV-Ts and GTV-Ns across all patients was 0.17 cm (range 0.08–0.39 cm) and 0.07 cm (range 0.04–0.33 cm), respectively. Median DSC relative to a STAPLE volume for GTV-Ts and GTV-Ns across all patients were 0.73 and 0.76, respectively. A significant correlation was seen between median DSCs and median volumes of GTV-Ts (Spearman correlation coefficient 0.76, p < 0.001) and of GTV-Ns (Spearman correlation coefficient 0.55, p < 0.001). Conclusion: Contouring GTVs in patients with HNC on MRI showed that the median IOV for GTV-T and GTV-N was below 2 mm, based on observes from two separate radiation departments. However, there are still specific regions in tumours that are difficult to resolve as either malignant tissue or oedema that potentially could be improved by further training in MR-only delineation.",

keywords = "Head and neck cancer, Inter-observer variation, MRI, Target delineation",

author = "Ruta Zukauskaite and Rumley, {Christopher N.} and Hansen, {Christian R.} and Jameson, {Michael G.} and Yuvnik Trada and J{\o}rgen Johansen and Niels Gyldenkerne and Eriksen, {Jesper G.} and Farhannah Aly and Christensen, {Rasmus L.} and Mark Lee and Carsten Brink and Lois Holloway",

year = "2022",

month = sep,

doi = "10.1016/j.ctro.2022.08.005",

language = "English",

volume = "36",

pages = "121--126",

journal = "Clinical and Translational Radiation Oncology",

issn = "2405-6308",

publisher = "Elsevier",

}

Delineation uncertainties of tumour volumes on MRI of head and neck cancer patients. / Zukauskaite, Ruta; Rumley, Christopher N.; Hansen, Christian R. et al.
I: Clinical and Translational Radiation Oncology, Bind 36, 09.2022, s. 121-126.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Delineation uncertainties of tumour volumes on MRI of head and neck cancer patients

AU - Zukauskaite, Ruta

AU - Rumley, Christopher N.

AU - Hansen, Christian R.

AU - Jameson, Michael G.

AU - Trada, Yuvnik

AU - Johansen, Jørgen

AU - Gyldenkerne, Niels

AU - Eriksen, Jesper G.

AU - Aly, Farhannah

AU - Christensen, Rasmus L.

AU - Lee, Mark

AU - Brink, Carsten

AU - Holloway, Lois

PY - 2022/9

Y1 - 2022/9

N2 - Background: During the last decade, radiotherapy using MR Linac has gone from research to clinical implementation for different cancer locations. For head and neck cancer (HNC), target delineation based only on MR images is not yet standard, and the utilisation of MRI instead of PET/CT in radiotherapy planning is not well established. We aimed to analyse the inter-observer variation (IOV) in delineating GTV (gross tumour volume) on MR images only for patients with HNC. Material/methods: 32 HNC patients from two independent departments were included. Four clinical oncologists from Denmark and four radiation oncologists from Australia had independently contoured primary tumour GTVs (GTV-T) and nodal GTVs (GTV-N) on T2-weighted MR images obtained at the time of treatment planning. Observers were provided with sets of images, delineation guidelines and patient synopsis. Simultaneous truth and performance level estimation (STAPLE) reference volumes were generated for each structure using all observer contours. The IOV was assessed using the DICE Similarity Coefficient (DSC) and mean absolute surface distance (MASD). Results: 32 GTV-Ts and 68 GTV-Ns were contoured per observer. The median MASD for GTV-Ts and GTV-Ns across all patients was 0.17 cm (range 0.08–0.39 cm) and 0.07 cm (range 0.04–0.33 cm), respectively. Median DSC relative to a STAPLE volume for GTV-Ts and GTV-Ns across all patients were 0.73 and 0.76, respectively. A significant correlation was seen between median DSCs and median volumes of GTV-Ts (Spearman correlation coefficient 0.76, p < 0.001) and of GTV-Ns (Spearman correlation coefficient 0.55, p < 0.001). Conclusion: Contouring GTVs in patients with HNC on MRI showed that the median IOV for GTV-T and GTV-N was below 2 mm, based on observes from two separate radiation departments. However, there are still specific regions in tumours that are difficult to resolve as either malignant tissue or oedema that potentially could be improved by further training in MR-only delineation.

AB - Background: During the last decade, radiotherapy using MR Linac has gone from research to clinical implementation for different cancer locations. For head and neck cancer (HNC), target delineation based only on MR images is not yet standard, and the utilisation of MRI instead of PET/CT in radiotherapy planning is not well established. We aimed to analyse the inter-observer variation (IOV) in delineating GTV (gross tumour volume) on MR images only for patients with HNC. Material/methods: 32 HNC patients from two independent departments were included. Four clinical oncologists from Denmark and four radiation oncologists from Australia had independently contoured primary tumour GTVs (GTV-T) and nodal GTVs (GTV-N) on T2-weighted MR images obtained at the time of treatment planning. Observers were provided with sets of images, delineation guidelines and patient synopsis. Simultaneous truth and performance level estimation (STAPLE) reference volumes were generated for each structure using all observer contours. The IOV was assessed using the DICE Similarity Coefficient (DSC) and mean absolute surface distance (MASD). Results: 32 GTV-Ts and 68 GTV-Ns were contoured per observer. The median MASD for GTV-Ts and GTV-Ns across all patients was 0.17 cm (range 0.08–0.39 cm) and 0.07 cm (range 0.04–0.33 cm), respectively. Median DSC relative to a STAPLE volume for GTV-Ts and GTV-Ns across all patients were 0.73 and 0.76, respectively. A significant correlation was seen between median DSCs and median volumes of GTV-Ts (Spearman correlation coefficient 0.76, p < 0.001) and of GTV-Ns (Spearman correlation coefficient 0.55, p < 0.001). Conclusion: Contouring GTVs in patients with HNC on MRI showed that the median IOV for GTV-T and GTV-N was below 2 mm, based on observes from two separate radiation departments. However, there are still specific regions in tumours that are difficult to resolve as either malignant tissue or oedema that potentially could be improved by further training in MR-only delineation.

KW - Head and neck cancer

KW - Inter-observer variation

KW - MRI

KW - Target delineation

UR - http://www.scopus.com/inward/record.url?scp=85135814353&partnerID=8YFLogxK

U2 - 10.1016/j.ctro.2022.08.005

DO - 10.1016/j.ctro.2022.08.005

M3 - Journal article

C2 - 36017132

AN - SCOPUS:85135814353

SN - 2405-6308

VL - 36

SP - 121

EP - 126

JO - Clinical and Translational Radiation Oncology

JF - Clinical and Translational Radiation Oncology

ER -

Delineation uncertainties of tumour volumes on MRI of head and neck cancer patients

Abstract

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