Interobserver variability in clinical target volume delineation in anal squamous cell carcinoma
Abstract We evaluated the inter-physician variability in the target contouring of the radiotherapy for anal squamous cell carcinoma (ASCC). Clinical target volume (CTV) of three patients diagnosed with ASCC was delineated by seven experienced radiation oncologists from multi-institution. These patie...
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doaj-22d7aa4645944c84831596e74ee079b82021-02-07T12:32:00ZengNature Publishing GroupScientific Reports2045-23222021-02-011111710.1038/s41598-021-82541-5Interobserver variability in clinical target volume delineation in anal squamous cell carcinomaKyung Su Kim0Kwang-Ho Cheong1Kyubo Kim2Taeryool Koo3Hyeon Kang Koh4Ji Hyun Chang5Ah Ram Chang6Hae Jin Park7Department of Radiation Oncology, Dongnam Institute of Radiological and Medical SciencesDepartment of Radiation Oncology, Hallym University Sacred Heart HospitalDepartment of Radiation Oncology, Ewha Womans University College of MedicineDepartment of Radiation Oncology, Hallym University Sacred Heart HospitalDepartment of Radiation Oncology, Konkuk University School of MedicineDepartment of Radiation Oncology, Seoul Metropolitan Government, Seoul National University Boramae Medical CenterDepartment of Radiation Oncology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of MedicineDepartment of Radiation Oncology, Hanyang University College of MedicineAbstract We evaluated the inter-physician variability in the target contouring of the radiotherapy for anal squamous cell carcinoma (ASCC). Clinical target volume (CTV) of three patients diagnosed with ASCC was delineated by seven experienced radiation oncologists from multi-institution. These patients were staged as pT1N1a, cT2N0, and cT4N1a, respectively, according to 8th edition of the American Joint Committee on Cancer staging system. Expert agreement was quantified using an expectation maximization algorithm for Simultaneous Truth and Performance Level Estimation (STAPLE). The maximum distance from the boundaries of the STAPLE generated volume with confidence level of 80% to those of the contour of each CTV in 6 directions was compared. CTV of pelvis which includes primary tumor, perirectal tissue and internal/external iliac lymph node (LN) area (CTV-pelvis) and CTV of inguinal area (CTV-inguinal) were obtained from the seven radiation oncologists. One radiation oncologist did not contain inguinal LN area in the treatment target volume of patient 2 (cT2N0 stage). CTV-inguinal displayed moderate agreement for each patient (overall kappa 0.58, 0.54 and 0.6, respectively), whereas CTV-pelvis showed substantial agreement (overall kappa 0.66, 0.68 and 0.64, respectively). Largest variation among each contour was shown in the inferior margin of the CTV-inguinal. For CTV-pelvis, anterior and superior margin showed the biggest variation. Overall, moderate to substantial agreement was shown for CTV delineation. However, large variations in the anterior and cranial boarder of the CTV-pelvis and the caudal margin of the CTV-inguinal suggest that further studies are needed to establish a clearer target volume delineation guideline.https://doi.org/10.1038/s41598-021-82541-5 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Kyung Su Kim Kwang-Ho Cheong Kyubo Kim Taeryool Koo Hyeon Kang Koh Ji Hyun Chang Ah Ram Chang Hae Jin Park |
spellingShingle |
Kyung Su Kim Kwang-Ho Cheong Kyubo Kim Taeryool Koo Hyeon Kang Koh Ji Hyun Chang Ah Ram Chang Hae Jin Park Interobserver variability in clinical target volume delineation in anal squamous cell carcinoma Scientific Reports |
author_facet |
Kyung Su Kim Kwang-Ho Cheong Kyubo Kim Taeryool Koo Hyeon Kang Koh Ji Hyun Chang Ah Ram Chang Hae Jin Park |
author_sort |
Kyung Su Kim |
title |
Interobserver variability in clinical target volume delineation in anal squamous cell carcinoma |
title_short |
Interobserver variability in clinical target volume delineation in anal squamous cell carcinoma |
title_full |
Interobserver variability in clinical target volume delineation in anal squamous cell carcinoma |
title_fullStr |
Interobserver variability in clinical target volume delineation in anal squamous cell carcinoma |
title_full_unstemmed |
Interobserver variability in clinical target volume delineation in anal squamous cell carcinoma |
title_sort |
interobserver variability in clinical target volume delineation in anal squamous cell carcinoma |
publisher |
Nature Publishing Group |
series |
Scientific Reports |
issn |
2045-2322 |
publishDate |
2021-02-01 |
description |
Abstract We evaluated the inter-physician variability in the target contouring of the radiotherapy for anal squamous cell carcinoma (ASCC). Clinical target volume (CTV) of three patients diagnosed with ASCC was delineated by seven experienced radiation oncologists from multi-institution. These patients were staged as pT1N1a, cT2N0, and cT4N1a, respectively, according to 8th edition of the American Joint Committee on Cancer staging system. Expert agreement was quantified using an expectation maximization algorithm for Simultaneous Truth and Performance Level Estimation (STAPLE). The maximum distance from the boundaries of the STAPLE generated volume with confidence level of 80% to those of the contour of each CTV in 6 directions was compared. CTV of pelvis which includes primary tumor, perirectal tissue and internal/external iliac lymph node (LN) area (CTV-pelvis) and CTV of inguinal area (CTV-inguinal) were obtained from the seven radiation oncologists. One radiation oncologist did not contain inguinal LN area in the treatment target volume of patient 2 (cT2N0 stage). CTV-inguinal displayed moderate agreement for each patient (overall kappa 0.58, 0.54 and 0.6, respectively), whereas CTV-pelvis showed substantial agreement (overall kappa 0.66, 0.68 and 0.64, respectively). Largest variation among each contour was shown in the inferior margin of the CTV-inguinal. For CTV-pelvis, anterior and superior margin showed the biggest variation. Overall, moderate to substantial agreement was shown for CTV delineation. However, large variations in the anterior and cranial boarder of the CTV-pelvis and the caudal margin of the CTV-inguinal suggest that further studies are needed to establish a clearer target volume delineation guideline. |
url |
https://doi.org/10.1038/s41598-021-82541-5 |
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