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Multicenter evaluation of different target volume delineation concepts in pediatric Hodgkin’s lymphoma

A case study

Multicenterevaluierung unterschiedlicher Zielvolumenkonzepte für pädiatrische Hodgkin-Erkrankungen

Eine Fallstudie

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Abstract

Background and purpose

In pediatric Hodgkin’s lymphoma (PHL) improvements in imaging and multiagent chemotherapy have allowed for a reduction in target volume. The involved-node (IN) concept is being tested in several treatment regimens for adult Hodgkin’s lymphoma. So far there is no consensus on the definition of the IN. To improve the reproducibility of the IN, we tested a new involved-node-level (INL) concept, using defined anatomical boundaries as basis for target delineation. The aim was to evaluate the feasibility of IN and INL concepts for PHL in terms of interobserver variability.

Patients and methods

The INL concept was defined for the neck and mediastinum by the PHL Radiotherapy Group based on accepted concepts for solid tumors. Seven radiation oncologists from six European centers contoured neck and mediastinal clinical target volumes (CTVs) of 2 patients according to the IN and the new INL concepts. The median CTVs, coefficient of variation (COV), and general conformity index (CI) were assessed. The intraclass correlation coefficient (ICC) for reliability of delineations was calculated.

Results

All observers agreed that INL is a feasible and practicable delineation concept resulting in stronger interobserver concordance than the IN (mediastinum CIINL = 0.39 vs. CIIN = 0.28, neck left CIINL = 0.33; CIIN = 0.18; neck right CIINL = 0.24, CIIN = 0.14). The COV showed less dispersion and the ICC indicated higher reliability of contouring for INL (ICCINL = 0.62, p < 0.05) as for IN (ICCIN = 0.40, p < 0.05).

Conclusion

INL is a practical and feasible alternative to IN resulting in more homogeneous target delineation, and it should be therefore considered as a future target volume concept in PHL.

Zusammenfassung

Hintergrund und Zielsetzung

Im Rahmen der risikoadaptierten Therapie und verbesserten Bildgebung konnte bei pädiatrischen Hodgkin-Erkrankungen (PHL) das Bestrahlungsvolumen sukzessiv verkleinert werden. Die Involved-node-Bestrahlung (IN) wird zurzeit in verschiedenen Studien an Erwachsenen durchgeführt. Bisher gibt es keine einheitliche IN-Definition. Um eine verbesserte Reproduzierbarkeit zu erreichen, wird die Involved-node-level-Bestrahlung (INL) als Zielvolumenkonzept eingesetzt. Studienziel war es, anhand von Analysen der Interbeobachtervariation die Umsetzbarkeit von IN und INL bei PHL zu überprüfen.

Patienten und Methoden

Entsprechend der IN- und INL-Definition konturierten 7 Strahlentherapeuten aus 6 europäischen Zentren ein zervikales und ein mediastinales klinisches Zielvolumen (CTV) von 2 PHL-Patienten. Das mediane CTV, der Variationskoeffizient (COV) und der Konfomitätsindex (CI) wurden ermittelt. Die Intraklassenkorrelation (ICC) wurde zur Bestimmung der Konturierungsreliabilität innerhalb des IN- und INL-Konzepts berechnet.

Ergebnisse

Das mediane CTVINL war größer als das mediane CTVIN. Die Interbeobachterübereinstimmung war bei der INL im Vergleich zur IN besser (Mediastinum: CIINL = 0,39; CIIN = 0,28; Hals links: CIINL = 0,33; CIIN = 0,18; Hals rechts: CIINL = 0,24; CIIN = 0,14). Der COV zeigte eine geringere Streuung bei der INL-Konturierung, die ICC weist eine bessere Konturierungsreliabilität innerhalb der INL (ICCINL = 0,62, p < 0,05) im Vergleich zur IN (ICCIN = 0,40, p < 0,05) auf.

Schlussfolgerung

Die INL ist eine praktikable und reproduzierbare Alternative zur IN, die zu einer homogeneren Konturierung führt und sich somit als Zielvolumenkonzept für PHL empfiehlt.

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Acknowledgments

The financial support of the Federal Ministry of Economy, Family and Youth and the National Foundation for Research, Technology and Development and the Austrian National Bank, project number 12972, are gratefully acknowledged. The authors would like to gratefully acknowledge the observers Christian Carrie, Line Claude, Eve Gallop-Evans, Jack Lindh, Carola Lütgendorf-Caucig, Thomas Kuhnt, Bela Malinova, and Tanja Pelz for donating their time contouring and making this study possible.

Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Radiooncology, Medical University of Vienna/AKH, Vienna, Austria

    C. Lütgendorf-Caucig MD, I. Fotina, B. Knäusl, D. Georg, R. Pötter & K. Dieckmann

  2. Velindre Cancer Centre, Whitchurch, Cardiff, UK

    E. Gallop-Evans

  3. Department of Radiation Oncology, Centre Léon Bérard, Lyon, France

    L. Claude

  4. Department of Radiation Sciences, Oncology, Umea University, Umea, Sweden

    J. Lindh

  5. Department of Radiotherapy, Martin Luther University Halle-Wittenberg, Halle, Germany

    T. Pelz

  6. Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna/AKH, Vienna, Austria

    B. Knäusl, D. Georg & K. Dieckmann

  7. Department of Radiotherapy, Medical University of Vienna/AKH, Währinger Gürtel 18-20, 1090, Vienna, Austria

    C. Lütgendorf-Caucig MD

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  1. C. Lütgendorf-Caucig MD
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  2. I. Fotina
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  3. E. Gallop-Evans
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  4. L. Claude
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  5. J. Lindh
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  6. T. Pelz
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  7. B. Knäusl
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  8. D. Georg
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  9. R. Pötter
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  10. K. Dieckmann
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EuroNet-PHL RT Group

Corresponding author

Correspondence to C. Lütgendorf-Caucig MD.

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Lütgendorf-Caucig, C., Fotina, I., Gallop-Evans, E. et al. Multicenter evaluation of different target volume delineation concepts in pediatric Hodgkin’s lymphoma. Strahlenther Onkol 188, 1025–1030 (2012). https://doi.org/10.1007/s00066-012-0182-4

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