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Objective: To create and compare consensus clinical target volume (CTV) contours for computed tomography (CT) and 3-Tesla (3-T) magnetic resonance (MR) image-based cervical-cancer brachytherapy.

Methods and Materials: Twenty-three experts in gynecologic radiation oncology contoured the same 3 cervical cancer brachytherapy cases: 1 stage IIB near-complete response (CR) case with a tandem and ovoid, 1 stage IIB partial response (PR) case with tandem and ovoid with needles, and 1 stage IB2 CR case with a tandem and ring applicator. The CT contours were completed before the MRI contours. These were analyzed for consistency and clarity of target delineation using an expectation maximization algorithm for simultaneous truth and performance level estimation (STAPLE), with κ statistics as a measure of agreement between participants. The conformity index was calculated for each of the 6 data sets. Dice coefficients were generated to compare the CT and MR contours of the same case.

Results: For all 3 cases, the mean tumor volume was smaller on MR than on CT (P<.001). The κ and conformity index estimates were slightly higher for CT, indicating a higher level of agreement on CT. The Dice coefficients were 89% for the stage IB2 case with a CR, 74% for the stage IIB case with a PR, and 57% for the stage IIB case with a CR.

Conclusion: In a comparison of MR-contoured with CT-contoured CTV volumes, the higher level of agreement on CT may be due to the more distinct contrast medium visible on the images at the time of brachytherapy. MR at the time of brachytherapy may be of greatest benefit in patients with large tumors with parametrial extension that have a partial or complete response to external beam. On the basis of these results, a 95% consensus volume was generated for CT and for MR. Online contouring atlases are available for instruction at http://www.nrgoncology.org/Resources/ContouringAtlases/GYNCervicalBrachytherapy.aspx.

Titel:	Comparison and consensus guidelines for delineation of clinical target volume for CT- and MR-based brachytherapy in locally advanced cervical cancer.
Autor/in / Beteiligte Person:	Viswanathan, AN ; Erickson, B ; Gaffney, DK ; Beriwal, S ; Bhatia, SK ; Lee Burnett O 3rd ; D'Souza, DP ; Patil, N ; Haddock, MG ; Jhingran, A ; Jones, EL ; Kunos, CA ; Lee, LJ ; Lin, LL ; Mayr, NA ; Petersen, I ; Petric, P ; Portelance, L ; Small W Jr ; Strauss, JB ; Townamchai, K ; Wolfson, AH ; Yashar, CM ; Bosch, W
Zeitschrift:	International journal of radiation oncology, biology, physics, Jg. 90 (2014-10-01), Heft 2, S. 320-8
Veröffentlichung:	New York, NY : Elsevier, Inc ; <i>Original Publication</i>: Elmsford, N. Y., Pergamon Press., 2014
Medientyp:	academicJournal
ISSN:	1879-355X (electronic)
DOI:	10.1016/j.ijrobp.2014.06.005
Schlagwort:	Adenocarcinoma diagnostic imaging Adenocarcinoma pathology Adenocarcinoma radiotherapy Brachytherapy instrumentation Female Humans Neoplasm, Residual Uterine Cervical Neoplasms radiotherapy Brachytherapy methods Consensus Magnetic Resonance Imaging methods Tomography, X-Ray Computed Tumor Burden Uterine Cervical Neoplasms diagnostic imaging Uterine Cervical Neoplasms pathology
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Comparative Study; Guideline; Journal Article; Research Support, N.I.H., Extramural Language: English [Int J Radiat Oncol Biol Phys] 2014 Oct 01; Vol. 90 (2), pp. 320-8. MeSH Terms: Consensus* ; Magnetic Resonance Imaging* / methods ; Tomography, X-Ray Computed* ; Tumor Burden* ; Brachytherapy / methods ; Uterine Cervical Neoplasms / diagnostic imaging ; Uterine Cervical Neoplasms / *pathology ; Adenocarcinoma / diagnostic imaging ; Adenocarcinoma / pathology ; Adenocarcinoma / radiotherapy ; Brachytherapy / instrumentation ; Female ; Humans ; Neoplasm, Residual ; Uterine Cervical Neoplasms / radiotherapy References: Int J Gynecol Cancer. 2009 Nov;19(8):1402-6. (PMID: 20009897) ; Brachytherapy. 2013 May-Jun;12(3):240-7. (PMID: 23415048) ; Radiother Oncol. 2011 Jul;100(1):116-23. (PMID: 21821305) ; Int J Radiat Oncol Biol Phys. 2005 Jul 1;62(3):901-11. (PMID: 15936576) ; Int J Radiat Oncol Biol Phys. 2012 Jan 1;82(1):250-5. (PMID: 21183288) ; Int J Radiat Oncol Biol Phys. 2010 Jan 1;76(1):104-9. (PMID: 19619956) ; Radiother Oncol. 2009 Nov;93(2):322-30. (PMID: 19748695) ; Radiother Oncol. 2010 Dec;97(3):572-8. (PMID: 20708285) ; Radiother Oncol. 2008 Nov;89(2):164-71. (PMID: 18789829) ; IEEE Trans Med Imaging. 2004 Jul;23(7):903-21. (PMID: 15250643) ; Int J Radiat Oncol Biol Phys. 1991 Jan;20(1):95-100. (PMID: 1993635) ; Radiother Oncol. 2010 Dec;97(3):507-13. (PMID: 21074881) ; Radiother Oncol. 2006 Jan;78(1):67-77. (PMID: 16403584) ; Radiother Oncol. 2013 Apr;107(1):6-12. (PMID: 23453539) ; Radiother Oncol. 2008 Aug;88(2):217-26. (PMID: 18037524) ; Brachytherapy. 2012 Jan-Feb;11(1):33-46. (PMID: 22265436) ; Radiother Oncol. 2010 Aug;96(2):161-5. (PMID: 20655120) ; Int J Radiat Oncol Biol Phys. 2008 Jul 1;71(3):756-64. (PMID: 18191335) ; Int J Radiat Oncol Biol Phys. 1995 Jul 30;32(5):1481-6. (PMID: 7635793) ; Radiother Oncol. 2012 Jun;103(3):305-13. (PMID: 22633469) ; Int J Radiat Oncol Biol Phys. 2012 Jul 1;83(3):e353-62. (PMID: 22483697) ; Int J Radiat Oncol Biol Phys. 2005 May 1;62(1):293-5; author reply 295-6. (PMID: 15850940) ; Magn Reson Imaging. 2012 Nov;30(9):1279-90. (PMID: 22898699) ; Med Phys. 2003 May;30(5):979-85. (PMID: 12773007) ; Clin Oncol (R Coll Radiol). 2009 Apr;21(3):175-82. (PMID: 19101130) ; Int J Gynecol Cancer. 2012 Jan;22(1):123-31. (PMID: 22193645) ; Radiother Oncol. 2005 Mar;74(3):235-45. (PMID: 15763303) ; Radiother Oncol. 2013 Apr;107(1):13-9. (PMID: 23462706) ; Radiother Oncol. 2009 May;91(2):166-72. (PMID: 19062118) ; Int J Radiat Oncol Biol Phys. 2007 Jun 1;68(2):491-8. (PMID: 17331668) Grant Information: U10 CA180868 United States CA NCI NIH HHS; UG1 CA233178 United States CA NCI NIH HHS; R21 CA167800 United States CA NCI NIH HHS; U10 CA180818 United States CA NCI NIH HHS; U24 CA180803 United States CA NCI NIH HHS; U10 CA180822 United States CA NCI NIH HHS; R21 167800 United States PHS HHS; U24 CA081647 United States CA NCI NIH HHS; CA81647 United States CA NCI NIH HHS Entry Date(s): Date Created: 20141012 Date Completed: 20141205 Latest Revision: 20220311 Update Code: 20240513 PubMed Central ID: PMC4194192

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Comparison and consensus guidelines for delineation of clinical target volume for CT- and MR-based brachytherapy in locally advanced cervical cancer.