Faculty Collaboration Database

Consensus Guidelines for Delineation of Clinical Target Volumes for Intensity Modulated Radiation Therapy for Intact Cervical Cancer: An Update. Pract Radiat Oncol 2025;15(2):171-179

Date

11/16/2024

Pubmed ID

39547646

Pubmed Central ID

PMC11954667

DOI

10.1016/j.prro.2024.11.004

Scopus ID

2-s2.0-85214526511 (requires institutional sign-in at Scopus site)   14 Citations

Abstract

PURPOSE: Accurate target delineation is essential when using intensity modulated radiation therapy for intact cervical cancer. In 2011, the Radiation Therapy Oncology Group published a consensus guideline using magnetic resonance imaging (MRI). The current project expands on the previous atlas by including computed tomography (CT)-based contours, contours with MRI and positron emission tomography (PET) registrations, the addition of common and complex scenarios, and incorporating information on simulation and treatment planning techniques.

METHODS AND MATERIALS: Twenty-eight experts in gynecologic radiation oncology contoured 3 cases, first on a noncontrast CT simulation scan and then with registered diagnostic scans. The cases included (1) International Federation of Gynecology and Obstetrics (FIGO) IIIC1 with a bulky tumor and vaginal metastasis, (2) FIGO IIB with calcified uterine fibromas, and (3) FIGO IIIC2 with large lymph nodes. The contours on all 6 data sets (3 CT simulations without diagnostic images and 3 with registered images) were analyzed for consistency of delineation using an expectation-maximization algorithm for simultaneous truth and performance level estimation with kappa statistics as a measure of agreement. The contours were reviewed, discussed, and edited in a group meeting prior to finalizing.

RESULTS: Contours showed considerable agreement among experts in each of the cases, with kappa statistics from 0.67 to 0.72. For each case, diagnostic PET ± MRI was associated with an increase in volume. The largest increase was the clinical target volume (CTV) primary for case 2, with a 20% increase in volume and a 54% increase in simultaneous truth and performance level estimation volume, which may be due to variance in registration priorities. For the third case, 92.9% increased their CTVs based on the addition of the diagnostic PET scan. The main areas of variance were in determining the superior extent of CTV coverage, coverage of the mesorectum, and simulation and planning protocols.

CONCLUSIONS: This study shows the value and the challenges of using coregistered diagnostic imaging, with an average increase in volumes when incorporating MRI and PET.

Author List

Fields EC, Bosch WR, Albuquerque KV, Bhatia R, Chino J, Dyer B, Erickson B, Fabian D, Gaffney D, Glaser S, Han K, Hathout L, Hsu IC, Jegadeesh N, Kahn J, Kidd E, Klopp A, Leung E, Lin L, Ludwig M, Ma T, Mell L, Mayadev J, Petersen I, Portelance L, Rash D, Taunk N, Viswanathan A, Wolfson A, Yashar C, Yeung A, Yoshida E, Fisher CM

Author

Beth A. Erickson MD Professor in the Radiation Oncology department at Medical College of Wisconsin

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

Consensus
Female
Humans
Magnetic Resonance Imaging
Positron-Emission Tomography
Radiotherapy Planning, Computer-Assisted
Radiotherapy, Intensity-Modulated
Tomography, X-Ray Computed
Uterine Cervical Neoplasms