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. 2022 Aug 6:36:121-126.
doi: 10.1016/j.ctro.2022.08.005. eCollection 2022 Sep.

Delineation uncertainties of tumour volumes on MRI of head and neck cancer patients

Ruta Zukauskaite  1   2   3 , Christopher N Rumley  2   4 , Christian R Hansen  2   3   5 , Michael G Jameson  2   6   7   8 , Yuvnik Trada  2   6 , Jørgen Johansen  1 , Niels Gyldenkerne  1 , Jesper G Eriksen  9 , Farhannah Aly  2   6 , Rasmus L Christensen  3   5 , Mark Lee  2   6 , Carsten Brink  3   5 , Lois Holloway  2   3   6
Affiliations

Delineation uncertainties of tumour volumes on MRI of head and neck cancer patients

Ruta Zukauskaite et al. Clin Transl Radiat Oncol. .

Abstract

Background: During the last decade, radiotherapy using MR Linac has gone from research to clinical implementation for different cancer locations. For head and neck cancer (HNC), target delineation based only on MR images is not yet standard, and the utilisation of MRI instead of PET/CT in radiotherapy planning is not well established. We aimed to analyse the inter-observer variation (IOV) in delineating GTV (gross tumour volume) on MR images only for patients with HNC.

Material/methods: 32 HNC patients from two independent departments were included. Four clinical oncologists from Denmark and four radiation oncologists from Australia had independently contoured primary tumour GTVs (GTV-T) and nodal GTVs (GTV-N) on T2-weighted MR images obtained at the time of treatment planning. Observers were provided with sets of images, delineation guidelines and patient synopsis. Simultaneous truth and performance level estimation (STAPLE) reference volumes were generated for each structure using all observer contours. The IOV was assessed using the DICE Similarity Coefficient (DSC) and mean absolute surface distance (MASD).

Results: 32 GTV-Ts and 68 GTV-Ns were contoured per observer. The median MASD for GTV-Ts and GTV-Ns across all patients was 0.17 cm (range 0.08-0.39 cm) and 0.07 cm (range 0.04-0.33 cm), respectively. Median DSC relative to a STAPLE volume for GTV-Ts and GTV-Ns across all patients were 0.73 and 0.76, respectively. A significant correlation was seen between median DSCs and median volumes of GTV-Ts (Spearman correlation coefficient 0.76, p < 0.001) and of GTV-Ns (Spearman correlation coefficient 0.55, p < 0.001).

Conclusion: Contouring GTVs in patients with HNC on MRI showed that the median IOV for GTV-T and GTV-N was below 2 mm, based on observes from two separate radiation departments. However, there are still specific regions in tumours that are difficult to resolve as either malignant tissue or oedema that potentially could be improved by further training in MR-only delineation.

Keywords: Head and neck cancer; Inter-observer variation; MRI; Target delineation.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
A: Mean absolute surface distance relative to a STAPLE volume for GTV-Ts across 32 patients among 8 observers; B: Mean absolute surface distance relative to a STAPLE volume for GTV-Ns across 32 patients among 8 observers.
Fig. 2
Fig. 2
A: The highest DSC for GTV-Ts, B: The lowest DSC for GTV_Ts, C: The highest DSC for GTV-Ns, D: The lowest DSC for GTV-Ns Contours in red: volumes by 8 observers; contours in blue STAPLE volume A and C: T1w Dixon water-only MRI; B and D: T2 weighted MRI. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Supplementary figure 1
Supplementary figure 1
A. DSC relative to a STAPLE volume for GTV-Ts across 32 patients among 8 observers according to volumes; B. DSC relative to a STAPLE volume for GTV-Ns across 32 patients among 8 observers according to volumes.
See this image and copyright information in PMC

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