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Guideline
. 2014 Oct 1;90(2):320-8.
doi: 10.1016/j.ijrobp.2014.06.005.

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

Akila N Viswanathan  1 , Beth Erickson  2 , David K Gaffney  3 , Sushil Beriwal  4 , Sudershan K Bhatia  5 , Omer Lee Burnett 3rd  6 , David P D'Souza  7 , Nikhilesh Patil  7 , Michael G Haddock  8 , Anuja Jhingran  9 , Ellen L Jones  10 , Charles A Kunos  11 , Larissa J Lee  12 , Lilie L Lin  13 , Nina A Mayr  14 , Ivy Petersen  8 , Primoz Petric  15 , Lorraine Portelance  16 , William Small Jr  17 , Jonathan B Strauss  18 , Kanokpis Townamchai  12 , Aaron H Wolfson  16 , Catheryn M Yashar  19 , Walter Bosch  20
Affiliations
Guideline

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

Akila N Viswanathan et al. Int J Radiat Oncol Biol Phys. .

Abstract

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.

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Figures

Figure 1
Figure 1
Axial, sagittal and coronal images of CT and MRI for case 1 showing a tandem and ovoid applicator with consensus contours for MR (light blue) and for CT (red)
Figure 2
Figure 2
Axial, sagittal and coronal images of CT and MRI for case 2 showing a tandem and ovoid with needles applicator with consensus contours for MR (light blue) and for CT (red)
Figure 3
Figure 3
Axial, sagittal and coronal images of CT and MRI for case 3 showing a tandem and ring applicator with consensus contours for MR (light blue) and for CT (red)
Figure 4
Figure 4
Figure 5
Figure 5
See this image and copyright information in PMC

References

    1. NCCN. Guidelines for Cervical Cancer. In. 2013
    1. Montana GS, Hanlon AL, Brickner TJ, et al. Carcinoma of the cervix: patterns of care studies: review of 1978, 1983, and 1988–1989 surveys. Int J Radiat Oncol Biol Phys. 1995;32:1481–1486. - PubMed
    1. Lanciano RM, Martz K, Coia LR, Hanks GE. Tumor and treatment factors improving outcome in stage III-B cervix cancer. International Journal of Radiation Oncology Biology and Physics. 1991;20:95–100. - PubMed
    1. Viswanathan AN, Cormack R, Rawal B, Lee H. Increasing brachytherapy dose predicts survival for interstitial and tandem-based radiation for stage IIIB cervical cancer. Int J Gynecol Cancer. 2009;19:1402–1406. - PubMed
    1. Viswanathan AN, Thomadsen B. American Brachytherapy Society consensus guidelines for locally advanced carcinoma of the cervix. Part I: general principles. Brachytherapy. 2012;11:33–46. - PubMed

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