International assessment of interobserver reproducibility of flap delineation in head and neck carcinoma

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  • Arnaud Beddok, Institut Curie, Universite Paris-Saclay
  • ,
  • Leslie Guzene, University Hospital of Amiens
  • ,
  • Alexandre Coutte, University Hospital of Amiens
  • ,
  • David Thomson, Christie Hospital NHS Foundation Trust
  • ,
  • Sue S Yom, University of California at San Francisco
  • ,
  • Valentin Calugaru, Institut Curie
  • ,
  • Eivind Blais, Polyclinique Marzet
  • ,
  • Olivier Gilliot, Polyclinique Marzet
  • ,
  • Séverine Racadot, Centre Leon Berard
  • ,
  • Yoann Pointreau, Centre Leon Berard
  • ,
  • June Corry, Radiation Oncology, GenesisCare, St. Vincent's Hospital, Melbourne, Victoria, AUSTRALIA.
  • ,
  • Kenneth Jensen
  • Sandro Porceddu, Princess Alexandra Hospital Southside Clinical Unit
  • ,
  • Nazim Khalladi, Centre François Baclesse
  • ,
  • Vianney Bastit, Centre François Baclesse
  • ,
  • Audrey Lasne-Cardon, Centre François Baclesse
  • ,
  • Pierre-Yves Marcy, Polyclinique les Fleurs
  • ,
  • Florent Carsuzaa, Poitiers University Hospital
  • ,
  • Christophe Nioche, Laboratoire d'Imagerie Translationnelle en Oncologie (LITO)
  • ,
  • Jean Bourhis, University of Lausanne
  • ,
  • Julia Salleron, Lorraine Cancer Institute
  • ,
  • Juliette Thariat, Centre François Baclesse, IN2P3-CNRS
  • ,
  • GORTEC

Background: 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.

OriginalsprogEngelsk
TidsskriftActa Oncologica
Vol/bind61
Nummer6
Sider (fra-til)672-679
Antal sider8
ISSN0284-186X
DOI
StatusUdgivet - 2022

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