title: Retroperitoneal sarcoma (RPS) high risk gross tumor volume boost (HR GTV boost) contour delineation agreement among NRG sarcoma radiation and surgical oncologists.
abstract: OBJECTIVE
  Curative intent management of retroperitoneal sarcoma (RPS) requires gross total resection. Preoperative radiotherapy (RT) often is used as an adjuvant to surgery, but recurrence rates remain high. To enhance RT efficacy with acceptable tolerance, there is interest in delivering "boost doses" of RT to high-risk areas of gross tumor volume (HR GTV) judged to be at risk for positive resection margins. We sought to evaluate variability in HR GTV boost target volume delineation among collaborating sarcoma radiation and surgical oncologist teams.
  
  
  METHODS
  Radiation planning CT scans for three cases of RPS were distributed to seven paired radiation and surgical oncologist teams at six institutions. Teams contoured HR GTV boost volumes for each case. Analysis of contour agreement was performed using the simultaneous truth and performance level estimation (STAPLE) algorithm and kappa statistics.
  
  
  RESULTS
  HRGTV boost volume contour agreement between the seven teams was "substantial" or "moderate" for all cases. Agreement was best on the torso wall posteriorly (abutting posterior chest abdominal wall) and medially (abutting ipsilateral para-vertebral space and great vessels). Contours varied more significantly abutting visceral organs due to differing surgical opinions regarding planned partial organ resection.
  
  
  CONCLUSIONS
  Agreement of RPS HRGTV boost volumes between sarcoma radiation and surgical oncologist teams was substantial to moderate. Differences were most striking in regions abutting visceral organs, highlighting the importance of collaboration between the radiation and surgical oncologist for "individualized" target delineation on the basis of areas deemed at risk and planned resection.
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital L2, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA, ebaldini@partners.org.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Baldini
authors.forename: Walter
authors.initials: W
authors.lastname: Bosch
authors.forename: John M
authors.initials: JM
authors.lastname: Kane
authors.forename: Ross A
authors.initials: RA
authors.lastname: Abrams
authors.forename: Kilian E
authors.initials: KE
authors.lastname: Salerno
authors.forename: Curtiland
authors.initials: C
authors.lastname: Deville
authors.forename: Chandrajit P
authors.initials: CP
authors.lastname: Raut
authors.forename: Ivy A
authors.initials: IA
authors.lastname: Petersen
authors.forename: Yen-Lin
authors.initials: YL
authors.lastname: Chen
authors.forename: John T
authors.initials: JT
authors.lastname: Mullen
authors.forename: Keith W
authors.initials: KW
authors.lastname: Millikan
authors.forename: Giorgos
authors.initials: G
authors.lastname: Karakousis
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kendrick
authors.forename: Thomas F
authors.initials: TF
authors.lastname: DeLaney
authors.forename: Dian
authors.initials: D
authors.lastname: Wang
mesh_terms: D000465:Algorithms; D032921:Consensus; D006801:Humans; D015588:Observer Variation; D058958:Organs at Risk; D017410:Practice Guidelines as Topic; D011379:Prognosis; D018787:Radiation Oncology; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D012186:Retroperitoneal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000532:radiotherapy; D012307:Risk Factors; D012509:Sarcoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000532:radiotherapy; D014057:Tomography, X-Ray Computed / Q000379:methods; D047368:Tumor Burden