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Consensus Guidelines for Delineation of Clinical Target Volumes for Intensity Modulated Radiation Therapy for Intact
Emma C Fields1, Walter R Bosch2, Kevin V Albuquerque3
1Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia.
Practical Radiation Oncology
|November 15, 2024
Summary
Accurate radiation therapy for cervical cancer is improved by combining CT, MRI, and PET scans. This study highlights the benefits and challenges of integrating these imaging techniques for better target delineation.
Area of Science:
- Radiation Oncology
- Medical Imaging
- Gynecologic Oncology
Background:
- Accurate target delineation is critical for intensity-modulated radiation therapy in cervical cancer.
- Previous guidelines (2011) relied on magnetic resonance imaging (MRI).
- This project expands on prior work by incorporating computed tomography (CT), MRI, and positron emission tomography (PET) registrations.
Purpose of the Study:
- To develop an updated atlas for cervical cancer radiation therapy target delineation.
- To include CT-based contours and registered MRI/PET data.
- To address common and complex clinical scenarios, simulation, and treatment planning.
Main Methods:
- Twenty-eight gynecologic radiation oncology experts contoured three distinct cervical cancer cases.
- Contouring was performed on CT simulation scans and registered diagnostic images (CT, MRI, PET).
- Expert agreement was assessed using kappa statistics and expectation-maximization algorithms.
Main Results:
- Experts showed considerable agreement (kappa 0.67-0.72) in target delineation.
- Integrating diagnostic PET/MRI generally increased clinical target volume (CTV) size.
- Key areas of variance included superior CTV extent, mesorectum coverage, and planning protocols.
Conclusions:
- Coregistered diagnostic imaging (MRI/PET) enhances target volume definition in cervical cancer radiotherapy.
- While valuable, integrating these advanced imaging techniques presents challenges in standardization.
- This study provides a foundation for improved contouring guidelines in complex cases.
