Interobserver Variability in Organ at Risk Delineation in Head and Neck Cancer

Overview

Journal Radiat Oncol

Publisher Biomed Central

Specialties Oncology
Radiology

Date 2021 Jun 29

PMID 34183040

Citations 27

Authors

J van der Veen

A Gulyban

S Willems

F Maes

S Nuyts

Affiliations

Soon will be listed here.

Abstract

Background: In radiotherapy inaccuracy in organ at risk (OAR) delineation can impact treatment plan optimisation and treatment plan evaluation. Brouwer et al. showed significant interobserver variability (IOV) in OAR delineation in head and neck cancer (HNC) and published international consensus guidelines (ICG) for OAR delineation in 2015. The aim of our study was to evaluate IOV in the presence of these guidelines.

Methods: HNC radiation oncologists (RO) from each Belgian radiotherapy centre were invited to complete a survey and submit contours for 5 HNC cases. Reference contours (OARref) were obtained by a clinically validated artificial intelligence-tool trained using ICG. Dice similarity coefficients (DSC), mean surface distance (MSD) and 95% Hausdorff distances (HD95) were used for comparison.

Results: Fourteen of twenty-two RO (64%) completed the survey and submitted delineations. Thirteen (93%) confirmed the use of delineation guidelines, of which six (43%) used the ICG. The OARs whose delineations agreed best with the OARref were mandible [median DSC 0.9, range (0.8-0.9); median MSD 1.1 mm, range (0.8-8.3), median HD95 3.4 mm, range (1.5-38.7)], brainstem [median DSC 0.9 (0.6-0.9); median MSD 1.5 mm (1.1-4.0), median HD95 4.0 mm (2.3-15.0)], submandibular glands [median DSC 0.8 (0.5-0.9); median MSD 1.2 mm (0.9-2.5), median HD95 3.1 mm (1.8-12.2)] and parotids [median DSC 0.9 (0.6-0.9); median MSD 1.9 mm (1.2-4.2), median HD95 5.1 mm (3.1-19.2)]. Oral cavity, cochleas, PCMs, supraglottic larynx and glottic area showed more variation. RO who used the consensus guidelines showed significantly less IOV (p = 0.008).

Conclusions: Although ICG for delineation of OARs in HNC exist, they are only implemented by about half of RO participating in this study, which partly explains the delineation variability. However, this study highlights that guidelines alone do not suffice to eliminate IOV and that more effort needs to be done to accomplish further treatment standardisation, for example with artificial intelligence.

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References

Rathod S, Gupta T, Ghosh-Laskar S, Murthy V, Budrukkar A, Agarwal J . Quality-of-life (QOL) outcomes in patients with head and neck squamous cell carcinoma (HNSCC) treated with intensity-modulated radiation therapy (IMRT) compared to three-dimensional conformal radiotherapy (3D-CRT): evidence from a prospective.... Oral Oncol. 2013; 49(6):634-42. DOI: 10.1016/j.oraloncology.2013.02.013. View

Nelms B, Tome W, Robinson G, Wheeler J . Variations in the contouring of organs at risk: test case from a patient with oropharyngeal cancer. Int J Radiat Oncol Biol Phys. 2010; 82(1):368-78. DOI: 10.1016/j.ijrobp.2010.10.019. View

Deeley M, Chen A, Datteri R, Noble J, Cmelak A, Donnelly E . Comparison of manual and automatic segmentation methods for brain structures in the presence of space-occupying lesions: a multi-expert study. Phys Med Biol. 2011; 56(14):4557-77. PMC: 3153124. DOI: 10.1088/0031-9155/56/14/021. View

Nutting C, Morden J, Harrington K, Urbano T, Bhide S, Clark C . Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol. 2011; 12(2):127-36. PMC: 3033533. DOI: 10.1016/S1470-2045(10)70290-4. View

van der Veen J, Gulyban A, Nuyts S . Interobserver variability in delineation of target volumes in head and neck cancer. Radiother Oncol. 2019; 137:9-15. DOI: 10.1016/j.radonc.2019.04.006. View

Mukesh M, Benson R, Jena R, Hoole A, Roques T, Scrase C . Interobserver variation in clinical target volume and organs at risk segmentation in post-parotidectomy radiotherapy: can segmentation protocols help?. Br J Radiol. 2012; 85(1016):e530-6. PMC: 3587102. DOI: 10.1259/bjr/66693547. View

Gregoire V, Langendijk J, Nuyts S . Advances in Radiotherapy for Head and Neck Cancer. J Clin Oncol. 2015; 33(29):3277-84. DOI: 10.1200/JCO.2015.61.2994. View

Brouwer C, Steenbakkers R, Bourhis J, Budach W, Grau C, Gregoire V . CT-based delineation of organs at risk in the head and neck region: DAHANCA, EORTC, GORTEC, HKNPCSG, NCIC CTG, NCRI, NRG Oncology and TROG consensus guidelines. Radiother Oncol. 2015; 117(1):83-90. DOI: 10.1016/j.radonc.2015.07.041. View

Bayman E, Prestwich R, Speight R, Aspin L, Garratt L, Wilson S . Patterns of failure after intensity-modulated radiotherapy in head and neck squamous cell carcinoma using compartmental clinical target volume delineation. Clin Oncol (R Coll Radiol). 2014; 26(10):636-42. DOI: 10.1016/j.clon.2014.05.001. View

10.

Cooper J, Mukherji S, Toledano A, Beldon C, Schmalfuss I, Amdur R . An evaluation of the variability of tumor-shape definition derived by experienced observers from CT images of supraglottic carcinomas (ACRIN protocol 6658). Int J Radiat Oncol Biol Phys. 2007; 67(4):972-5. PMC: 1892281. DOI: 10.1016/j.ijrobp.2006.10.029. View

11.

Brouwer C, Steenbakkers R, van den Heuvel E, Duppen J, Navran A, Bijl H . 3D Variation in delineation of head and neck organs at risk. Radiat Oncol. 2012; 7:32. PMC: 3337234. DOI: 10.1186/1748-717X-7-32. View

12.

Gupta T, Agarwal J, Jain S, Phurailatpam R, Kannan S, Ghosh-Laskar S . Three-dimensional conformal radiotherapy (3D-CRT) versus intensity modulated radiation therapy (IMRT) in squamous cell carcinoma of the head and neck: a randomized controlled trial. Radiother Oncol. 2012; 104(3):343-8. DOI: 10.1016/j.radonc.2012.07.001. View

13.

Genovesi D, Perrotti F, Trignani M, Di Pilla A, Vinciguerra A, Augurio A . Delineating brachial plexus, cochlea, pharyngeal constrictor muscles and optic chiasm in head and neck radiotherapy: a CT-based model atlas. Radiol Med. 2014; 120(4):352-60. DOI: 10.1007/s11547-014-0448-2. View

14.

Hermans R, Feron M, Bellon E, Dupont P, Van Den Bogaert W, Baert A . Laryngeal tumor volume measurements determined with CT: a study on intra- and interobserver variability. Int J Radiat Oncol Biol Phys. 1998; 40(3):553-7. DOI: 10.1016/s0360-3016(97)00853-5. View

15.

Due A, Vogelius I, Aznar M, Bentzen S, Berthelsen A, Korreman S . Recurrences after intensity modulated radiotherapy for head and neck squamous cell carcinoma more likely to originate from regions with high baseline [18F]-FDG uptake. Radiother Oncol. 2014; 111(3):360-5. PMC: 4469149. DOI: 10.1016/j.radonc.2014.06.001. View

16.

Rasch C, Eisbruch A, Remeijer P, Bos L, Hoogeman M, Van Herk M . Irradiation of paranasal sinus tumors, a delineation and dose comparison study. Int J Radiat Oncol Biol Phys. 2002; 52(1):120-7. DOI: 10.1016/s0360-3016(01)01751-5. View

17.

Ghosh-Laskar S, Yathiraj P, Dutta D, Rangarajan V, Purandare N, Gupta T . Prospective randomized controlled trial to compare 3-dimensional conformal radiotherapy to intensity-modulated radiotherapy in head and neck squamous cell carcinoma: Long-term results. Head Neck. 2015; 38 Suppl 1:E1481-7. DOI: 10.1002/hed.24263. View

18.

Nuyts S, Dirix P, Clement P, Vander Poorten V, Delaere P, Schoenaers J . Impact of adding concomitant chemotherapy to hyperfractionated accelerated radiotherapy for advanced head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 2008; 73(4):1088-95. DOI: 10.1016/j.ijrobp.2008.05.042. View

19.

van der Veen J, Willems S, Deschuymer S, Robben D, Crijns W, Maes F . Benefits of deep learning for delineation of organs at risk in head and neck cancer. Radiother Oncol. 2019; 138:68-74. DOI: 10.1016/j.radonc.2019.05.010. View

20.

Geets X, Daisne J, Arcangeli S, Coche E, De Poel M, Duprez T . Inter-observer variability in the delineation of pharyngo-laryngeal tumor, parotid glands and cervical spinal cord: comparison between CT-scan and MRI. Radiother Oncol. 2005; 77(1):25-31. DOI: 10.1016/j.radonc.2005.04.010. View