title: Interobserver variation of clinical target volume delineation in gastric cancer.
abstract: OBJECTIVE
  To evaluate interobserver variability in clinical target volume (CTV) delineation in gastric cancer performed with the help of a delineation guide.
  
  
  METHODS
  Ten radiotherapy centers that participate in the CRITICS Phase III trial were provided with a delineation atlas, preoperative CT scans, a postoperative planning CT scan, and clinical information for a gastric cancer case and were asked to construct a CTV and create a dosimetric plan according to departmental policy.
  
  
  RESULTS
  The volumes of the CTVs and planning target volumes (PTVs) differed greatly, with a mean (SD) CTV volume of 392 (176) cm(3) (range, 240-821 cm(3)) and PTV volume of 915 (312) cm(3) (range, 634-1677 cm(3)). The overlapping volume was 376 cm(3) for the CTV and 890 cm(3) for the PTV. The greatest differences in the CTV were seen at the cranial and caudal parts. After planning, dose coverage of the overlapping PTV volume showed less variability than the CTV.
  
  
  CONCLUSIONS
  In this series of 10 plans, variability of the CTV in postoperative chemoradiotherapy for gastric cancer is large. Strict and clear delineation guidelines should be provided, especially in Phase III multicenter studies. Adaptations of these guidelines should be evaluated in clinical studies.
authors.affiliation: Department of Radiotherapy, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. epm.jansen@nki.nl
authors.forename: Edwin P M
authors.initials: EP
authors.lastname: Jansen
authors.forename: Jasper
authors.initials: J
authors.lastname: Nijkamp
authors.forename: Michael
authors.initials: M
authors.lastname: Gubanski
authors.forename: Pehr A R M
authors.initials: PA
authors.lastname: Lind
authors.forename: Marcel
authors.initials: M
authors.lastname: Verheij
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D002173:Cancer Care Facilities; D005260:Female; D006801:Humans; D007668:Kidney / Q000528:radiation effects; D008488:Medical Illustration; D008875:Middle Aged; D009426:Netherlands; D015588:Observer Variation; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D013548:Sweden; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden