Interobserver variability in target definition for hepatocellular carcinoma with and without portal vein thrombus

Radiation therapy oncology group consensus guidelines

Theodore S. Hong, Walter R. Bosch, Sunil Krishnan, Tae K. Kim, Harvey J. Mamon, Paul Shyn, Edgar Ben-Josef, Jinsil Seong, Michael G. Haddock, Jason C. Cheng, Mary U. Feng, Kevin L. Stephans, David Roberge, Christopher Crane, Laura A. Dawson

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Purpose Defining hepatocellular carcinoma (HCC) gross tumor volume (GTV) requires multimodal imaging, acquired in different perfusion phases. The purposes of this study were to evaluate the variability in contouring and to establish guidelines and educational recommendations for reproducible HCC contouring for treatment planning. Methods and Materials Anonymous, multiphasic planning computed tomography scans obtained from 3 patients with HCC were identified and distributed to a panel of 11 gastrointestinal radiation oncologists. Panelists were asked the number of HCC cases they treated in the past year. Case 1 had no vascular involvement, case 2 had extensive portal vein involvement, and case 3 had minor branched portal vein involvement. The agreement between the contoured total GTVs (primary + vascular GTV) was assessed using the generalized kappa statistic. Agreement interpretation was evaluated using Landis and Koch's interpretation of strength of agreement. The S95 contour, defined using the simultaneous truth and performance level estimation (STAPLE) algorithm consensus at the 95% confidence level, was created for each case. Results Of the 11 panelists, 3 had treated >25 cases in the past year, 2 had treated 10 to 25 cases, 2 had treated 5 to 10 cases, 2 had treated 1 to 5 cases, 1 had treated 0 cases, and 1 did not respond. Near perfect agreement was seen for case 1, and substantial agreement was seen for cases 2 and 3. For case 2, there was significant heterogeneity in the volume identified as tumor thrombus (range 0.58-40.45 cc). For case 3, 2 panelists did not include the branched portal vein thrombus, and 7 panelists contoured thrombus separately from the primary tumor, also showing significant heterogeneity in volume of tumor thrombus (range 4.52-34.27 cc). Conclusions In a group of experts, excellent agreement was seen in contouring total GTV. Heterogeneity exists in the definition of portal vein thrombus that may impact treatment planning, especially if differential dosing is contemplated. Guidelines for HCC GTV contouring are recommended.

Original languageEnglish
Pages (from-to)804-813
Number of pages10
JournalInternational Journal of Radiation Oncology Biology Physics
Volume89
Issue number4
DOIs
Publication statusPublished - 2014 Jul 15

Fingerprint

Radiation Oncology
Observer Variation
Portal Vein
Tumor Burden
veins
Hepatocellular Carcinoma
radiation therapy
Thrombosis
Radiotherapy
tumors
cancer
Guidelines
planning
Blood Vessels
Multimodal Imaging
Neoplasms
Perfusion
Tomography
recommendations
confidence

All Science Journal Classification (ASJC) codes

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Hong, Theodore S. ; Bosch, Walter R. ; Krishnan, Sunil ; Kim, Tae K. ; Mamon, Harvey J. ; Shyn, Paul ; Ben-Josef, Edgar ; Seong, Jinsil ; Haddock, Michael G. ; Cheng, Jason C. ; Feng, Mary U. ; Stephans, Kevin L. ; Roberge, David ; Crane, Christopher ; Dawson, Laura A. / Interobserver variability in target definition for hepatocellular carcinoma with and without portal vein thrombus : Radiation therapy oncology group consensus guidelines. In: International Journal of Radiation Oncology Biology Physics. 2014 ; Vol. 89, No. 4. pp. 804-813.
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title = "Interobserver variability in target definition for hepatocellular carcinoma with and without portal vein thrombus: Radiation therapy oncology group consensus guidelines",
abstract = "Purpose Defining hepatocellular carcinoma (HCC) gross tumor volume (GTV) requires multimodal imaging, acquired in different perfusion phases. The purposes of this study were to evaluate the variability in contouring and to establish guidelines and educational recommendations for reproducible HCC contouring for treatment planning. Methods and Materials Anonymous, multiphasic planning computed tomography scans obtained from 3 patients with HCC were identified and distributed to a panel of 11 gastrointestinal radiation oncologists. Panelists were asked the number of HCC cases they treated in the past year. Case 1 had no vascular involvement, case 2 had extensive portal vein involvement, and case 3 had minor branched portal vein involvement. The agreement between the contoured total GTVs (primary + vascular GTV) was assessed using the generalized kappa statistic. Agreement interpretation was evaluated using Landis and Koch's interpretation of strength of agreement. The S95 contour, defined using the simultaneous truth and performance level estimation (STAPLE) algorithm consensus at the 95{\%} confidence level, was created for each case. Results Of the 11 panelists, 3 had treated >25 cases in the past year, 2 had treated 10 to 25 cases, 2 had treated 5 to 10 cases, 2 had treated 1 to 5 cases, 1 had treated 0 cases, and 1 did not respond. Near perfect agreement was seen for case 1, and substantial agreement was seen for cases 2 and 3. For case 2, there was significant heterogeneity in the volume identified as tumor thrombus (range 0.58-40.45 cc). For case 3, 2 panelists did not include the branched portal vein thrombus, and 7 panelists contoured thrombus separately from the primary tumor, also showing significant heterogeneity in volume of tumor thrombus (range 4.52-34.27 cc). Conclusions In a group of experts, excellent agreement was seen in contouring total GTV. Heterogeneity exists in the definition of portal vein thrombus that may impact treatment planning, especially if differential dosing is contemplated. Guidelines for HCC GTV contouring are recommended.",
author = "Hong, {Theodore S.} and Bosch, {Walter R.} and Sunil Krishnan and Kim, {Tae K.} and Mamon, {Harvey J.} and Paul Shyn and Edgar Ben-Josef and Jinsil Seong and Haddock, {Michael G.} and Cheng, {Jason C.} and Feng, {Mary U.} and Stephans, {Kevin L.} and David Roberge and Christopher Crane and Dawson, {Laura A.}",
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Hong, TS, Bosch, WR, Krishnan, S, Kim, TK, Mamon, HJ, Shyn, P, Ben-Josef, E, Seong, J, Haddock, MG, Cheng, JC, Feng, MU, Stephans, KL, Roberge, D, Crane, C & Dawson, LA 2014, 'Interobserver variability in target definition for hepatocellular carcinoma with and without portal vein thrombus: Radiation therapy oncology group consensus guidelines', International Journal of Radiation Oncology Biology Physics, vol. 89, no. 4, pp. 804-813. https://doi.org/10.1016/j.ijrobp.2014.03.041

Interobserver variability in target definition for hepatocellular carcinoma with and without portal vein thrombus : Radiation therapy oncology group consensus guidelines. / Hong, Theodore S.; Bosch, Walter R.; Krishnan, Sunil; Kim, Tae K.; Mamon, Harvey J.; Shyn, Paul; Ben-Josef, Edgar; Seong, Jinsil; Haddock, Michael G.; Cheng, Jason C.; Feng, Mary U.; Stephans, Kevin L.; Roberge, David; Crane, Christopher; Dawson, Laura A.

In: International Journal of Radiation Oncology Biology Physics, Vol. 89, No. 4, 15.07.2014, p. 804-813.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Interobserver variability in target definition for hepatocellular carcinoma with and without portal vein thrombus

T2 - Radiation therapy oncology group consensus guidelines

AU - Hong, Theodore S.

AU - Bosch, Walter R.

AU - Krishnan, Sunil

AU - Kim, Tae K.

AU - Mamon, Harvey J.

AU - Shyn, Paul

AU - Ben-Josef, Edgar

AU - Seong, Jinsil

AU - Haddock, Michael G.

AU - Cheng, Jason C.

AU - Feng, Mary U.

AU - Stephans, Kevin L.

AU - Roberge, David

AU - Crane, Christopher

AU - Dawson, Laura A.

PY - 2014/7/15

Y1 - 2014/7/15

N2 - Purpose Defining hepatocellular carcinoma (HCC) gross tumor volume (GTV) requires multimodal imaging, acquired in different perfusion phases. The purposes of this study were to evaluate the variability in contouring and to establish guidelines and educational recommendations for reproducible HCC contouring for treatment planning. Methods and Materials Anonymous, multiphasic planning computed tomography scans obtained from 3 patients with HCC were identified and distributed to a panel of 11 gastrointestinal radiation oncologists. Panelists were asked the number of HCC cases they treated in the past year. Case 1 had no vascular involvement, case 2 had extensive portal vein involvement, and case 3 had minor branched portal vein involvement. The agreement between the contoured total GTVs (primary + vascular GTV) was assessed using the generalized kappa statistic. Agreement interpretation was evaluated using Landis and Koch's interpretation of strength of agreement. The S95 contour, defined using the simultaneous truth and performance level estimation (STAPLE) algorithm consensus at the 95% confidence level, was created for each case. Results Of the 11 panelists, 3 had treated >25 cases in the past year, 2 had treated 10 to 25 cases, 2 had treated 5 to 10 cases, 2 had treated 1 to 5 cases, 1 had treated 0 cases, and 1 did not respond. Near perfect agreement was seen for case 1, and substantial agreement was seen for cases 2 and 3. For case 2, there was significant heterogeneity in the volume identified as tumor thrombus (range 0.58-40.45 cc). For case 3, 2 panelists did not include the branched portal vein thrombus, and 7 panelists contoured thrombus separately from the primary tumor, also showing significant heterogeneity in volume of tumor thrombus (range 4.52-34.27 cc). Conclusions In a group of experts, excellent agreement was seen in contouring total GTV. Heterogeneity exists in the definition of portal vein thrombus that may impact treatment planning, especially if differential dosing is contemplated. Guidelines for HCC GTV contouring are recommended.

AB - Purpose Defining hepatocellular carcinoma (HCC) gross tumor volume (GTV) requires multimodal imaging, acquired in different perfusion phases. The purposes of this study were to evaluate the variability in contouring and to establish guidelines and educational recommendations for reproducible HCC contouring for treatment planning. Methods and Materials Anonymous, multiphasic planning computed tomography scans obtained from 3 patients with HCC were identified and distributed to a panel of 11 gastrointestinal radiation oncologists. Panelists were asked the number of HCC cases they treated in the past year. Case 1 had no vascular involvement, case 2 had extensive portal vein involvement, and case 3 had minor branched portal vein involvement. The agreement between the contoured total GTVs (primary + vascular GTV) was assessed using the generalized kappa statistic. Agreement interpretation was evaluated using Landis and Koch's interpretation of strength of agreement. The S95 contour, defined using the simultaneous truth and performance level estimation (STAPLE) algorithm consensus at the 95% confidence level, was created for each case. Results Of the 11 panelists, 3 had treated >25 cases in the past year, 2 had treated 10 to 25 cases, 2 had treated 5 to 10 cases, 2 had treated 1 to 5 cases, 1 had treated 0 cases, and 1 did not respond. Near perfect agreement was seen for case 1, and substantial agreement was seen for cases 2 and 3. For case 2, there was significant heterogeneity in the volume identified as tumor thrombus (range 0.58-40.45 cc). For case 3, 2 panelists did not include the branched portal vein thrombus, and 7 panelists contoured thrombus separately from the primary tumor, also showing significant heterogeneity in volume of tumor thrombus (range 4.52-34.27 cc). Conclusions In a group of experts, excellent agreement was seen in contouring total GTV. Heterogeneity exists in the definition of portal vein thrombus that may impact treatment planning, especially if differential dosing is contemplated. Guidelines for HCC GTV contouring are recommended.

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