Variation in the definition of clinical target volumes for pelvic nodal conformal radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys 2009 Jun 01;74(2):377-82
Date
10/25/2008Pubmed ID
18947941Pubmed Central ID
PMC2905162DOI
10.1016/j.ijrobp.2008.08.003Scopus ID
2-s2.0-67349210198 (requires institutional sign-in at Scopus site) 57 CitationsAbstract
PURPOSE: We conducted a comparative study of clinical target volume (CTV) definition of pelvic lymph nodes by multiple genitourinary (GU) radiation oncologists looking at the levels of discrepancies amongst this group.
METHODS AND MATERIALS: Pelvic computed tomography (CT) scans from 2 men were distributed to 14 Radiation Therapy Oncology Group GU radiation oncologists with instructions to define CTVs for the iliac and presacral lymph nodes. The CT data with contours were then returned for analysis. In addition, a questionnaire was completed that described the physicians' method for target volume definition.
RESULTS: Significant variation in the definition of the iliac and presacral CTVs was seen among the physicians. The minimum, maximum, mean (SD) iliac volumes (mL) were 81.8, 876.6, 337.6 +/- 203 for case 1 and 60.3, 627.7, 251.8 +/- 159.3 for case 2. The volume of 100% agreement was 30.6 and 17.4 for case 1 and 2 and the volume of the union of all contours was 1,012.0 and 807.4 for case 1 and 2, respectively. The overall agreement was judged to be moderate in both cases (kappa = 0.53 (p < 0.0001) and kappa = 0.48 (p < 0.0001). There was no volume of 100% agreement for either of the two presacral volumes. These variations were confirmed in the responses to the associated questionnaire.
CONCLUSIONS: Significant disagreement exists in the definition of the CTV for pelvic nodal radiation therapy among GU radiation oncology specialists. A consensus needs to be developed so as to accurately assess the merit and safety of such treatment.
Author List
Lawton CA, Michalski J, El-Naqa I, Kuban D, Lee WR, Rosenthal SA, Zietman A, Sandler H, Shipley W, Ritter M, Valicenti R, Catton C, Roach M 3rd, Pisansky TM, Seider MMESH terms used to index this publication - Major topics in bold
AdenocarcinomaConsensus
Humans
Lymph Nodes
Lymphatic Irradiation
Male
Middle Aged
Pelvis
Prostatic Neoplasms
Radiation Oncology
Radiography
Radiotherapy Dosage
Radiotherapy, Conformal
Rectum
Tumor Burden
Urinary Bladder
Urology
