Multicenter evaluation of different target volume delineation concepts in pediatric Hodgkin's lymphoma. A case study.
OBJECTIVE
In pediatric Hodgkin's lymphoma (PHL) improvements in imaging and multiagent chemotherapy have allowed for a reduction in target volume. The involved-node (IN) concept is being tested in several treatment regimens for adult Hodgkin's lymphoma. So far there is no consensus on the definition of the IN. To improve the reproducibility of the IN, we tested a new involved-node-level (INL) concept, using defined anatomical boundaries as basis for target delineation. The aim was to evaluate the feasibility of IN and INL concepts for PHL in terms of interobserver variability.


METHODS
The INL concept was defined for the neck and mediastinum by the PHL Radiotherapy Group based on accepted concepts for solid tumors. Seven radiation oncologists from six European centers contoured neck and mediastinal clinical target volumes (CTVs) of 2 patients according to the IN and the new INL concepts. The median CTVs, coefficient of variation (COV), and general conformity index (CI) were assessed. The intraclass correlation coefficient (ICC) for reliability of delineations was calculated.


RESULTS
All observers agreed that INL is a feasible and practicable delineation concept resulting in stronger interobserver concordance than the IN (mediastinum CI(INL) = 0.39 vs. CI(IN) = 0.28, neck left CI(INL) = 0.33; CI(IN) = 0.18; neck right CI(INL) = 0.24, CI(IN) = 0.14). The COV showed less dispersion and the ICC indicated higher reliability of contouring for INL (ICC(INL) = 0.62, p < 0.05) as for IN (ICC(IN) = 0.40, p < 0.05).


CONCLUSIONS
INL is a practical and feasible alternative to IN resulting in more homogeneous target delineation, and it should be therefore considered as a future target volume concept in PHL.
Department of Radiooncology, Medical University of Vienna/AKH, Vienna, Austria. carola.luetgendorf-caucig@meduniwien.ac.at
C
C
Lütgendorf-Caucig
I
I
Fotina
E
E
Gallop-Evans
L
L
Claude
J
J
Lindh
T
T
Pelz
B
B
Knäusl
D
D
Georg
R
R
Pötter
K
K
Dieckmann
D000293:Adolescent; D005240:Feasibility Studies; D005260:Female; D006689:Hodgkin Disease / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D009367:Neoplasm Staging; D015588:Observer Variation; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D047368:Tumor Burden / Q000528:radiation effects