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Interobserver variability of clinical target volume delineation in supra-diaphragmatic Hodgkin’s disease

A multi-institutional experience

Inter-Beobachter-Variabilität der CTV-Definition bei supradiaphragmatischer Hodgkin-Krankheit: eine multiinstitutionelle Untersuchung

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Background:

To determine interobserver variability in clinical target volume (CTV) of supra-diaphragmatic Hodgkin’s lymphoma.

Materials and Methods:

At the 2008 AIRO (Italian Society of Radiation Oncology) Meeting, the Radiation Oncology Department of Chieti proposed a multi-institutional contouring dummy-run of two cases of early stage supra-diaphragmatic Hodgkin’s lymphoma after chemotherapy. Clinical history, diagnostics, and planning CT imaging were available on Chieti’s radiotherapy website (www.radioterapia.unich.it). Participating centers were requested to delineate the CTV and submit it to the coordinating center. To quantify interobserver variability of CTV delineations, the total volume, craniocaudal, laterolateral, and anteroposterior diameters were calculated.

Results:

A total of 18 institutions for case A and 15 institutions for case B submitted the targets. Case A presented significant variability in total volume (range: 74.1–1,157.1 cc), craniocaudal (range: 6.5–22.5 cm; median: 16.25 cm), anteroposterior (range: 5.04–14.82 cm; median: 10.28 cm), and laterolateral diameters (range: 8.23–22.88 cm; median: 15.5 cm). Mean CTV was 464.8 cc (standard deviation: 280.5 cc). Case B presented significant variability in total volume (range: 341.8–1,662 cc), cranio-caudal (range: 8.0–28.5 cm; median: 23 cm), anteroposterior (range: 7.9–1.8 cm; median: 11.1 cm), and laterolateral diameters (range: 12.9–24.0 cm; median: 18.8 cm). Mean CTV was 926.0 cc (standard deviation: 445.7 cc).

Conclusion:

This significant variability confirms the need to apply specific guidelines to improve contouring uniformity in Hodgkin’s lymphoma.

Ziel:

Diese Studie wurde durchgeführt, um die Inter-Beobachter-Variabilität des klinischen Zielvolumens bei supradiaphragmatischem Hodgkin-Lymphom festzustellen.

Methodik:

Beim 18. Treffen der AIRO (Italienischen Gesellschaft für Radioonkologie) in Mailand (November 2008) schlug die Abteilung für Strahlentherapie/Radioonkologie von Chieti eine multiinstitutionelle Zielvolumen-Konturierung („Dummy-run“) von zwei Fällen supradiaphragmatischer Hodgkin-Lymphome im frühen Stadium nach der Chemotherapie vor. Informationen über den klinischer Verlauf, die diagnostischen Befunde und die Planungs-CT-Bildgebung standen auf der Website (www.radioterapia.unich.it) der Abteilung für Strahlentherapie/Radioonkologie der Universität Chieti zur Verfügung. Die teilnehmenden Zentren wurden gebeten, die klinischen Zielvolumina zu definieren und ihre Ergebnisse bei der Koordinierungsstelle einzureichen. Um die Inter-Beobachter-Variabilität bei der Konturierung des klinischen Zielvolumens zu quantifizieren, wurden das Gesamtvolumen (cc), die kraniokaudalen, laterolateralen und die anteroposterioren Durchmesser (cm) berechnet.

Ergebnisse:

18 Zentren bezüglich des Falls A und 15 Zentren bezüglich des Falls B haben Zielvolumen-Definitionen eingereicht. Dabei wurden signifikante Variationen bei der Konturierung des klinischen Zielvolumens festgestellt. Der Range der Volumendefinition im Fall A reichte von 74,1 bis zu 1157,1 cc (Abbildung 1). Diese Variationen wurden bei der Messung der kraniokaudalen (durchschnittlich 16,25 cm; Range 6,5–22,5 cm) (Abbildung 2), anteroposterioren (durchschnittlich 10,28 cm; Range 5,04–14,82 cm) (Abbildung 3) und laterolateralen Durchmesser (durchschnittlich 15,5 cm; Range 8,23–22,88 cm) (Abbildung 4) bestätigt (Tabelle 1). Der Durchschnitt der klinischen Zielvolumina war 464,8 cc mit einer Standardabweichung von 280,5 cc. Der Range der Volumendefinition im Fall B reichte von 341,8 bis zu 1662 cc (Abbildung 1); und diese Variationen wurden bei der Messung der kraniokaudalen (durchschnittlich 23 cm; Range 8,0–28,5 cm) (Abbildung 5), anteroposterioren (durchschnittlich 11,1 cm; Range 7,9–14,8 cm) (Abbildung 6) und laterolateralen Durchmesser (durchschnittlich 18,8 cm; Range 12,9–24,0 cm) (Abbildung 7) bestätigt (Tabelle 2). Der Durchschnitt der klinischen Zielvolumina war 926,0 cc mit einer Standardabweichung von 445,7 cc.

Schlussfolgerung:

Diese signifikante Variabilität bestätigt die Notwendigkeit der Anwendung von spezifischen Guidelines, um die Uniformität der Konturierung bei Hodgkin-Lymphomen zu verbessern.

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Authors and Affiliations

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

    Domenico Genovesi, Giampiero Ausili Cèfaro, Annamaria Vinciguerra, Antonietta Augurio, Monica Di Tommaso & Rita Marchese

  2. Department of Medical and Surgical Sciences, Radiation Oncology Unit, University of Turin, Turin, Italy

    Umberto Ricardi & Andrea Riccardo Filippi

  3. Department of Radiation Oncology, Institute Gustave Roussy, Villejuif, France

    Theodore Girinsky

  4. Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro, Chieti, Italy

    Katiuscia Di Biagio & Maurizio Belfiglio

  5. Radiotherapy Department, Policlinico Universitario S. Orsola, Bologna, Italy

    Enza Barbieri

  6. Radiotherapy Department, Policlinico Universitario “A. Gemelli”, Catholic University, Rome, Italy

    Vincenzo Valentini

  7. Istituto di Radioterapia, Ospedale Clinicizzato “SS. Annunziata”, via dei Vestini, 66100, Chieti, Italy

    Domenico Genovesi

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  1. Domenico Genovesi
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  2. Giampiero Ausili Cèfaro
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  9. Theodore Girinsky
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Correspondence to Domenico Genovesi.

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Genovesi, ., Cèfaro, G.A., Vinciguerra, A. et al. Interobserver variability of clinical target volume delineation in supra-diaphragmatic Hodgkin’s disease. Strahlenther Onkol 187, 357–366 (2011). https://doi.org/10.1007/s00066-011-2221-y

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