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Clinical and Translational Oncology

, Volume 18, Issue 5, pp 480–488 | Cite as

Clinical target volume in postoperative radiotherapy for gastric cancer: identification of major difficulties and controversies

  • J. SochaEmail author
  • G. Wołąkiewicz
  • E. Wasilewska-Teśluk
  • P. Janiga
  • T. Kondraciuk
  • A. Majewska
  • K. Olearski
  • L. Kępka
Research Article

Abstract

Purpose

To identify the main difficulties in postoperative clinical target volume (CTV) delineation in gastric cancer (GC).

Methods

Before and after a training course, 20 radiation oncology residents were asked to delineate the CTV for the postoperative GC case on four computed tomography scans: dome of the diaphragm, anterior abdominal wall, duodenal stump and porta hepatis level, and to determine the lower CTV border. CTV volume was reconstructed from requested planar contours. Area of intersection (AI) for each requested scan and volume of intersection (VI), defined as the overlap of delineated area/volume with respective reference area (RA)/reference volume (RV) proposed by the senior radiation oncologist, were computed. The degree of agreement between the reference and participants’ contours was quantified using the Concordance Index (CI): AI/RA × 100 % or VI/RV × 100 %. The lower CTV border was analyzed separately. Pre- and post-training CIs were compared. A questionnaire investigated the difficulties with contouring.

Results

Mean CI value was the lowest for the dome of the diaphragm (24 % pre-training, 35 % post-training) and for the duodenal stump (49 % pre-training, 61 % post-training). Mean CI for the CTV volume was 49 % pre-training and 59 % post-training, p = 0.39. Mean distance from the reference to the participants’ lower CTV borders was 2.73 cm pre-training and 2.0 cm post-training, p = 0.71. In a questionnaire, 75 % of respondents indicated the elective nodal area as the main difficulty.

Conclusions

Delineation of the dome of the diaphragm and the duodenal stump, as yet not recognized as the source of variation, should be addressed in the international consensus guidelines and clarified.

Keywords

Adjuvant radiotherapy Gastric cancer Interobserver variation Radiotherapy planning Volume delineation 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

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Supplementary material 1 (TIFF 33984 kb)
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Supplementary material 2 (TIFF 33984 kb)

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Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2015

Authors and Affiliations

  • J. Socha
    • 1
    Email author
  • G. Wołąkiewicz
    • 2
  • E. Wasilewska-Teśluk
    • 2
  • P. Janiga
    • 3
  • T. Kondraciuk
    • 4
  • A. Majewska
    • 5
  • K. Olearski
    • 6
  • L. Kępka
    • 2
  1. 1.Radiotherapy DepartmentRegional Oncology CenterCzestochowaPoland
  2. 2.Radiotherapy DepartmentIndependent Public Health Care Facility of the Ministry of the Interior and Warmian & Mazurian Oncology CentreOlsztynPoland
  3. 3.Radiotherapy DepartmentGreater Poland Cancer CenterPoznanPoland
  4. 4.Radiotherapy DepartmentSubcarpathian Cancer CenterBrzozowPoland
  5. 5.Radiotherapy DepartmentWest Pomeranian Oncology CenterSzczecinPoland
  6. 6.Radiotherapy DepartmentRegional Oncology CenterTarnówPoland

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