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Interobserver variability in target volume delineation of hepatocellular carcinoma

An analysis of the working group “Stereotactic Radiotherapy” of the German Society for Radiation Oncology (DEGRO)

Interobservervariabilität bei der Zielvolumendefinition für hepatozelluläre Karzinome

Eine Analyse der Arbeitsgruppe „Stereotaktische Radiotherapie“ der Deutschen Gesellschaft für Radioonkologie (DEGRO)

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Abstract

Background

Definition of gross tumor volume (GTV) in hepatocellular carcinoma (HCC) requires dedicated imaging in multiple contrast medium phases. The aim of this study was to evaluate the interobserver agreement (IOA) in gross tumor delineation of HCC in a multicenter panel.

Methods

The analysis was performed within the “Stereotactic Radiotherapy” working group of the German Society for Radiation Oncology (DEGRO). The GTVs of three anonymized HCC cases were delineated by 16 physicians from nine centers using multiphasic CT scans. In the first case the tumor was well defined. The second patient had multifocal HCC (one conglomerate and one peripheral tumor) and was previously treated with transarterial chemoembolization (TACE). The peripheral lesion was adjacent to the previous TACE site. The last patient had an extensive HCC with a portal vein thrombosis (PVT) and an inhomogeneous liver parenchyma due to cirrhosis. The IOA was evaluated according to Landis and Koch.

Results

The IOA for the first case was excellent (kappa: 0.85); for the second case moderate (kappa: 0.48) for the peripheral tumor and substantial (kappa: 0.73) for the conglomerate. In the case of the peripheral tumor the inconsistency is most likely explained by the necrotic tumor cavity after TACE caudal to the viable tumor. In the last case the IOA was fair, with a kappa of 0.34, with significant heterogeneity concerning the borders of the tumor and the PVT.

Conclusion

The IOA was very good among the cases were the tumor was well defined. In complex cases, where the tumor did not show the typical characteristics, or in cases with Lipiodol (Guerbet, Paris, France) deposits, IOA agreement was compromised.

Zusammenfassung

Hintergrund

Die Definition des makroskopischen Tumorvolumens (GTV) bei hepatozellulären Karzinomen (HCC) erfordert eine dezidierte Bildgebung in mehreren Kontrastmittelphasen. Ziel dieser Studie war es, die Interobservervariabilität (IOA) bei der Konturierung von HCC-Läsionen durch ein multizentrisches Panel zu evaluieren.

Methoden

Die Analyse wurde von der Arbeitsgruppe Stereotaxie der deutschen Gesellschaft für Radioonkologie (DEGRO) durchgeführt. Die GTVs von 3 anonymisierten HCC-Patienten wurden von 16 Ärzten aus 9 Zentren mit Expertise in der Leberstereotaxie anhand multiphasischer Computertomogramme (CT) beurteilt. Beim ersten Patienten war der Tumor sehr gut abgrenzbar. Der zweite Patient hatte ein multilokuläres HCC (ein Konglomerat und ein peripherer Herd) und war zuvor mittels transarterieller Chemoembolisation (TACE) behandelt worden. Der periphere Herd lag direkt neben der TACE-Stelle. Der dritte Patient hatte einen schwer abzugrenzenden Tumor wegen ausgedehnten Leberinhomogenitäten bei ausgeprägter Leberzirrhose und einer begleitenden Pfortaderthrombose (PVT). Die IOA wurde nach Landis und Koch evaluiert.

Ergebnisse

Die IOA war beim ersten Patienten exzellent (Kappa: 0,85); im zweiten Fall moderat (Kappa: 0,48) für den peripheren Herd und substanziell (Kappa 0,73) für das Konglomerat. Beim peripheren Herd ist diese Inkonsistenz durch TACE kaudal des Tumors entstanden. Beim dritten Patienten war die IOA mit einem Kappa-Wert von 0,34 ausreichend aufgrund signifikanter Heterogenität hinsichtlich der genauen Tumorabgrenzung und dem PVT.

Diskussion

Die IOA war bei den gut abgrenzbaren Tumoren sehr gut. In komplexeren Fällen mit Perfussionsinhomogenitäten oder Lipiodolanreicherung durch Vortherapien war die IOA beeinträchtigt.

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Acknowledgements

The authors would like to thank G. Rückers for the statistical consulting.

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Authors and Affiliations

  1. Department of Radiation Oncology, Medical Center – University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg im Breisgau, Germany

    E. Gkika, S. Kirste, H. C. Rischke, U. Nestle, A. L. Grosu & T. B. Brunner

  2. Department of Radiation Oncology, University Hospital Zürich, Zurich, Switzerland

    S. Tanadini-Lang, N. Andratschke & M. Guckenberger

  3. Department of Visceral Surgery, Medical Center – University of Freiburg, Freiburg, Germany

    P. A. Holzner & H. P. Neeff

  4. Department of Nuclear Medicine, Medical Center – University of Freiburg, Freiburg, Germany

    H. C. Rischke

  5. Department of Radiation Oncology, University Hospital Halle-Wittenberg, Halle-Wittenberg, Germany

    T. Reese

  6. Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

    F. Lohaus

  7. Institute of Innovative Radiotherapy, Department of Radiation Sciences, Helmholtz Zentrum Munich, Munich, Germany

    M. N. Duma

  8. Department of Radiation Oncology, General Hospital Vienna, Medical University Vienna, Vienna, Austria

    K. Dieckmann

  9. Department of Radiation Oncology, University Hospital of Cologne, Cologne, Germany

    R. Semrau

  10. Department of Radiation Oncology, University Hospital Mainz, Mainz, Germany

    M. Stockinger

  11. Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt, Germany

    D. Imhoff

  12. Department of Radiology, Medical Center – University of Freiburg, Freiburg, Germany

    N. Kremers

  13. Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany

    M. F. Häfner

  14. German Cancer Research Center (DKFZ), Heidelberg, Germany

    F. Lohaus

  15. OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

    F. Lohaus

  16. National Center for Tumor Diseases (NCT), Dresden, Germany

    F. Lohaus

  17. Faculty of Medicine, University of Freiburg, Freiburg, Germany

    U. Nestle, A. L. Grosu & T. B. Brunner

  18. partner site Freiburg, German Cancer Consortium (DKTK), Freiburg, Germany

    U. Nestle, A. L. Grosu & T. B. Brunner

  19. Department of Radiation Oncology, Klinikum Rechts der Isar, TU Munich, Munich, Germany

    M. N. Duma

  20. Saphir Radiosurgery Center, Frankfurt, Germany

    D. Imhoff

  21. German Cancer Consortium (DKTK) partner site Dresden, Dresden, Germany

    F. Lohaus

  22. German cancer Research Center (DKFZ), Heidelberg, Germany

    U. Nestle, A. L. Grosu & T. B. Brunner

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  1. E. Gkika
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  2. S. Tanadini-Lang
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Corresponding author

Correspondence to E. Gkika.

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Conflict of interest

E. Gkika, S. Tanadini-Lang, S. Kirste, P.A. Holzner, H.P. Neeff, H.C. Rischke, T. Reese, F. Lohaus, M.N. Duma, K. Dieckmann, R. Semrau, M. Stockinger, D. Imhoff, N. Kremers, M.F. Häfner, N. Andratschke, U. Nestle, A.L. Grosu, M. Guckenberger, and T.B. Brunner declare that they have no competing interests.

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Gkika, E., Tanadini-Lang, S., Kirste, S. et al. Interobserver variability in target volume delineation of hepatocellular carcinoma. Strahlenther Onkol 193, 823–830 (2017). https://doi.org/10.1007/s00066-017-1177-y

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