Evaluation of a target contouring protocol for 3D conformal radiotherapy in non-small cell lung cancer.
BACKGROUND
A protocol for the contouring of target volumes in lung cancer was implemented. Subsequently, a study was performed in order to determine the intra and inter-clinician variations in contoured volumes.


METHODS
Six radiation oncologists (RO) contoured the gross tumour volume (GTV) and/or clinical target volume (CTV), and planning target volume (PTV) for three patients with non-small cell lung cancer (NSCLC), on two separate occasions. These were, respectively, a well-circumscribed T1N0M0 lesion, an irregularly shaped T2N0M0 lesion, and a T2N2M0 tumour. Detailed diagnostic radiology reports were provided and contours were entered into a 3D planning system. The target volumes were calculated and beams-eye view (BEV) plots were generated to visualise differences in contouring. A software tool was used to expand the GTV and CTV in three dimensions for an automatically derived PTV.


RESULTS
Significant inter-RO variations in contoured target volumes were observed for all patients, and these were greater than intra-RO differences. The ratio of the largest to smallest contoured volume ranged from 1.6 for the GTV in the T1N0 lesion, to 2.0 for the PTV in the T2N2 lesion. The BEV plots revealed significant inter-RO variations in contouring the mediastinal CTV. The PTV's derived using a 3D margin programme were larger than manually contoured PTV's. These variations did not correlate with the experience of ROs.


CONCLUSIONS
Despite the use of an institutional contouring protocol, significant interclinician variations persist in contouring target volumes in NSCLC. Additional measures to decrease such variations should be incorporated into clinical trials.
Senan
S
S
Department of Radiation Oncology, Daniel den Hoed Cancer Centre, University Hospital Rotterdam, The Netherlands.
van Sörnsen de Koste
J
J
Samson
M
M
Tankink
H
H
Jansen
P
P
Nowak
P J
PJ
Krol
A D
AD
Schmitz
P
P
Lagerwaard
F J
FJ
D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000532:radiotherapy*; D003287:Contrast Media / Q000008:administration & dosage; D005069:Evaluation Studies as Topic; D006801:Humans; D007275:Injections, Intravenous; D008168:Lung / Q000528:radiation effects; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008482:Mediastinum / Q000528:radiation effects; D009367:Neoplasm Staging; D015588:Observer Variation; D018787:Radiation Oncology; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D020266:Radiotherapy, Conformal; D012984:Software; D014057:Tomography, X-Ray Computed
D003287:Contrast Media