Faculty Collaboration Database

NRG brain tumor specialists consensus guidelines for glioblastoma contouring. J Neurooncol 2019 May;143(1):157-166

Date

03/20/2019

Pubmed ID

30888558

Pubmed Central ID

PMC6483830

DOI

10.1007/s11060-019-03152-9

Scopus ID

2-s2.0-85063194539 (requires institutional sign-in at Scopus site)   54 Citations

Abstract

INTRODUCTION: NRG protocols for glioblastoma allow for clinical target volume (CTV) reductions at natural barriers; however, literature examining CTV contouring and the relevant white matter pathways is lacking. This study proposes consensus CTV guidelines, with a focus on areas of controversy while highlighting common errors in glioblastoma target delineation.

METHODS: Ten academic radiation oncologists specializing in brain tumor treatment contoured CTVs on four glioblastoma cases. CTV expansions were based on NRG trial guidelines. Contour consensus was assessed and summarized by kappa statistics. A meeting was held to discuss the mathematically averaged contours and form consensus contours and recommendations.

RESULTS: Contours of the cavity plus enhancement (mean kappa 0.69) and T2-FLAIR signal (mean kappa 0.74) showed moderate to substantial agreement. Experts were asked to trim off anatomic barriers while respecting pathways of spread to develop their CTVs. Submitted CTV_4600 (mean kappa 0.80) and CTV_6000 (mean kappa 0.81) contours showed substantial to near perfect agreement. Simultaneous truth and performance level estimation (STAPLE) contours were then reviewed and modified by group consensus. Anatomic trimming reduced the amount of total brain tissue planned for radiation targeting by a 13.6% (range 8.7-17.9%) mean proportional reduction. Areas for close scrutiny of target delineation were described, with accompanying recommendations.

CONCLUSIONS: Consensus contouring guidelines were established based on expert contours. Careful delineation of anatomic pathways and barriers to spread can spare radiation to uninvolved tissue without compromising target coverage. Further study is necessary to accurately define optimal target volumes beyond isometric expansion techniques for individual patients.

Author List

Kruser TJ, Bosch WR, Badiyan SN, Bovi JA, Ghia AJ, Kim MM, Solanki AA, Sachdev S, Tsien C, Wang TJC, Mehta MP, McMullen KP

MESH terms used to index this publication - Major topics in bold

Brain Neoplasms
Clinical Protocols
Glioblastoma
Humans
Magnetic Resonance Imaging
Practice Guidelines as Topic
Radiotherapy Planning, Computer-Assisted