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Inter-observer variability of clinical target volume delineation in definitive radiotherapy of neck lymph node metastases from unknown primary. A cooperative study of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Head and Neck Group

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Abstract

Background

This study, promoted by Italian Association of Radiotherapy and Clinical Oncology (AIRO) Head and Neck Group, aimed to assess the current national practice of target volume delineation on a case of neck lymph node metastases from unknown primary evaluating inter-observer variability, in a setting of primary radiotherapy.

Materials and methods

A case of metastatic neck lymph node from occult primary was proposed to 17 radiation oncologists. A national reference RT center was identified and considered as benchmark. Participants were requested to delineate target volumes. A structured questionnaire was administered. A comparison between following parameters of the CTVs was performed: centroids distances, Dice similarity index (DSI), Jaccard index and mean distance to agreement (MDA). Volume expressed in cubic centimeters and CTVs cranio-caudal extension were evaluated.

Results

Sixteen of 17 radiation oncologists recommended three CTVs dose levels. (CTV HD, CTV ID and CTV LD); CTV ID was not delineated by one of the participants and by the reference center. The distance between the reference centroid and the mean centroid of CTVs HD was 1.09 cm (0.36–3.99 cm); for CTV LD, a mean centroids distance of 2.45 (0.27–4.83 cm) was found, and for CTV HD, mean DSI is 0.48 and mean Jaccard index is 0.32 and MDA was 8.89 mm. CTV LD showed a mean DSI of 0.46, mean Jaccard index of 0.31 and MDA of 14.87 when compared to the reference.

Conclusion

Many aspects concerning treatment optimization of cervical nodes metastases from occult primary remain unclear, and we found a notable heterogeneity of global radiotherapy management reporting discordances both in target volume delineation and volume prescription.

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Authors and Affiliations

  1. Department of Radiation Oncology, SS. Annunziata Hospital, “G. D’Annunzio” University of Chieti, Chieti, Italy

    Marianna Trignani, Saide Di Biase & Domenico Genovesi

  2. Radiation Oncology Department, Istituto Nazionale Tumori-IRCSS-Fondazione G. Pascale, Naples, Italy

    Angela Argenone

  3. Radiation Oncology Department, Ospedale Policlinico Umberto I, Rome, Italy

    Daniela Musio

  4. Radiation Oncology Department, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy

    Anna Merlotti

  5. Radiation Oncology Department, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy

    Stefano Ursino

  6. Radiation Oncology Department, Fondazione IRCCS-Istituto Nazionale dei Tumori, Milan, Italy

    Ester Orlandi

  7. Radiation Oncology Department, Ospedale Policlinico San Martino, Università di Genova, Genoa, Italy

    Almalina Bacigalupo

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  1. Marianna Trignani
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Correspondence to Marianna Trignani.

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Trignani, M., Argenone, A., Di Biase, S. et al. Inter-observer variability of clinical target volume delineation in definitive radiotherapy of neck lymph node metastases from unknown primary. A cooperative study of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Head and Neck Group. Radiol med 124, 682–692 (2019). https://doi.org/10.1007/s11547-019-01006-y

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