Proposal for the delineation of neoadjuvant target volumes in oesophageal cancer

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  • Melissa Thomas, KU Leuven, University Hospitals Leuven
  • ,
  • Hanna R. Mortensen
  • Lone Hoffmann
  • Ditte S. Møller
  • Esther G.C. Troost, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf
  • ,
  • Christina T. Muijs, University of Groningen
  • ,
  • Maaike Berbee, Maastricht University Medical Centre
  • ,
  • Rebecca Bütof, Technische Universität Dresden
  • ,
  • Owen Nicholas, Swansea Bay University Health Board
  • ,
  • Ganesh Radhakrishna, Christie Hospital NHS Foundation Trust
  • ,
  • Gilles Defraene, KU Leuven
  • ,
  • Philippe Nafteux, University Hospitals Leuven
  • ,
  • Marianne Nordsmark
  • Karin Haustermans, KU Leuven, University Hospitals Leuven

Purpose: To define instructions for delineation of target volumes in the neoadjuvant setting in oesophageal cancer. Materials and methods: Radiation oncologists of five European centres participated in the following consensus process: [1] revision of published (MEDLINE) and national/institutional delineation guidelines; [2] first delineation round of five cases (patient 1–5) according to national/institutional guidelines; [3] consensus meeting to discuss the results of step 1 and 2, followed by a target volume delineation proposal; [4] circulation of proposed instructions for target volume delineation and atlas for feedback; [5] second delineation round of five new cases (patient 6–10) to peer review and validate (two additional centres) the agreed delineation guidelines and atlas; [6] final consensus on the delineation guidelines depicted in an atlas. Target volumes of the delineation rounds were compared between centres by Dice similarity coefficient (DSC) and maximum/mean undirected Hausdorff distances (Hmax/Hmean). Results: In the first delineation round, the consistency between centres was moderate (CTVtotal: DSC = 0.59–0.88; Hmean = 0.2–0.4 cm). Delineations in the second round were much more consistent. Lowest variability was obtained between centres participating in the consensus meeting (CTVtotal: DSC: p < 0.050 between rounds for patients 6/7/8/10; Hmean: p < 0.050 for patients 7/8/10), compared to validation centres (CTVtotal: DSC: p < 0.050 between validation and consensus meeting centres for patients 6/7/8; Hmean: p < 0.050 for patients 7/10). A proposal for delineation of target volumes and an atlas were generated. Conclusion: We proposed instructions for target volume delineation and an atlas for the neoadjuvant radiation treatment in oesophageal cancer. These will enable a more uniform delineation of patients in clinical practice and clinical trials.

Original languageEnglish
JournalRadiotherapy and Oncology
Volume156
Pages (from-to)102-112
Number of pages11
ISSN0167-8140
DOIs
Publication statusPublished - Mar 2021

    Research areas

  • Consensus, Delineation atlas, Neoadjuvant chemoradiation, Oesophageal cancer, Proposal for delineation

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