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. 2016 Jul 15;95(4):1191-200.
doi: 10.1016/j.ijrobp.2016.02.043. Epub 2016 Feb 21.

Consensus Recommendations for Radiation Therapy Contouring and Treatment of Vulvar Carcinoma

David K Gaffney  1 , Bronwyn King  2 , Akila N Viswanathan  3 , Maroie Barkati  4 , Sushil Beriwal  5 , Patricia Eifel  6 , Beth Erickson  7 , Anthony Fyles  8 , Jennifer Goulart  9 , Matthew Harkenrider  10 , Anuja Jhingran  6 , Ann Klopp  6 , Wui-Jin Koh  11 , Karen Lim  12 , Ivy Petersen  13 , Lorraine Portelance  14 , William Small Jr  10 , Alexandra Stewart  15 , Ericka Wiebe  16 , Aaron Wolfson  14 , Catheryn Yashar  17 , Walter Bosch  18
Affiliations

Consensus Recommendations for Radiation Therapy Contouring and Treatment of Vulvar Carcinoma

David K Gaffney et al. Int J Radiat Oncol Biol Phys. .

Abstract

Purpose: The purpose of this study was to develop a radiation therapy (RT) contouring atlas and recommendations for women with postoperative and locally advanced vulvar carcinoma.

Methods and materials: An international committee of 35 expert gynecologic radiation oncologists completed a survey of the treatment of vulvar carcinoma. An initial set of recommendations for contouring was discussed and generated by consensus. Two cases, 1 locally advanced and 1 postoperative, were contoured by 14 physicians. Contours were compared and analyzed using an expectation-maximization algorithm for simultaneous truth and performance level estimation (STAPLE), and a 95% confidence interval contour was developed. The level of agreement among contours was assessed using a kappa statistic. STAPLE contours underwent full committee editing to generate the final atlas consensus contours.

Results: Analysis of the 14 contours showed substantial agreement, with kappa statistics of 0.69 and 0.64 for cases 1 and 2, respectively. There was high specificity for both cases (≥99%) and only moderate sensitivity of 71.3% and 64.9% for cases 1 and 2, respectively. Expert review and discussion generated consensus recommendations for contouring target volumes and treatment for postoperative and locally advanced vulvar cancer.

Conclusions: These consensus recommendations for contouring and treatment of vulvar cancer identified areas of complexity and controversy. Given the lack of clinical research evidence in vulvar cancer radiation therapy, the committee advocates a conservative and consistent approach using standardized recommendations.

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Conflict of interest statement

All other authors report no conflicts of interest.

Figures

Fig. 1
Fig. 1
Consensus contour (yellow), modified consensus contour (red), and individual contours from 14 different physicians for a locally advanced vulvar case (case 1) (A) and postoperative case (case 2) (B). The modified consensus contour was retracted from the space between the vulva and groin (white arrow) and skin surface (blue arrow) when it was believed to be at low risk.
Fig. 2
Fig. 2
(A–E) Axial slices from a locally advanced case, showing modified consensus contour. (F–J) Consensus contour in the postoperative case. Additionally, the space deep to the femoral vessels was not included in the CTV (blue arrows). The locally advanced case had satellite lesions (E orange arrow), an uncommon clinical scenario; hence, the CTV extended inferior to the medial thigh. Abbreviation: CTV = clinical target volume.
Fig. 3
Fig. 3
A coronal (A) and sagittal (B) slice from a locally advanced case and for the postoperative case (C and D) with the modified consensus contour shown. External iliac vessels are shown in cyan (A), femoral vessels in yellow (A), and saphenous vessels in green (A). Evaluation of coronal and sagittal images is essential for accurate delineation of the vulvar and groin CTV. Coronal images can be useful for identifying the lateral extent of the vulva (white arrow), and on the sagittal images, extension into the vagina is specifically included within the CTV (red arrows).
Fig. 4
Fig. 4
Volumetric 3D rendering of the modified consensus contour (red) is shown with external iliac vessels in cyan, femoral vessels in yellow, and saphenous vessels in green, from a locally advanced case (A) and from a postoperative case (B).
See this image and copyright information in PMC

References

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