title: Expert Consensus Contouring Guidelines for Intensity Modulated Radiation Therapy in Esophageal and Gastroesophageal Junction Cancer.
abstract: OBJECTIVE
  Current guidelines for esophageal cancer contouring are derived from traditional 2-dimensional fields based on bony landmarks, and they do not provide sufficient anatomic detail to ensure consistent contouring for more conformal radiation therapy techniques such as intensity modulated radiation therapy (IMRT). Therefore, we convened an expert panel with the specific aim to derive contouring guidelines and generate an atlas for the clinical target volume (CTV) in esophageal or gastroesophageal junction (GEJ) cancer.
  
  
  METHODS
  Eight expert academically based gastrointestinal radiation oncologists participated. Three sample cases were chosen: a GEJ cancer, a distal esophageal cancer, and a mid-upper esophageal cancer. Uniform computed tomographic (CT) simulation datasets and accompanying diagnostic positron emission tomographic/CT images were distributed to each expert, and the expert was instructed to generate gross tumor volume (GTV) and CTV contours for each case. All contours were aggregated and subjected to quantitative analysis to assess the degree of concordance between experts and to generate draft consensus contours. The panel then refined these contours to generate the contouring atlas.
  
  
  RESULTS
  The κ statistics indicated substantial agreement between panelists for each of the 3 test cases. A consensus CTV atlas was generated for the 3 test cases, each representing common anatomic presentations of esophageal cancer. The panel agreed on guidelines and principles to facilitate the generalizability of the atlas to individual cases.
  
  
  CONCLUSIONS
  This expert panel successfully reached agreement on contouring guidelines for esophageal and GEJ IMRT and generated a reference CTV atlas. This atlas will serve as a reference for IMRT contours for clinical practice and prospective trial design. Subsequent patterns of failure analyses of clinical datasets using these guidelines may require modification in the future.
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, New York. Electronic address: wua@mskcc.org.
authors.forename: Abraham J
authors.initials: AJ
authors.lastname: Wu
authors.affiliation: Washington University, St. Louis, Missouri.
authors.forename: Walter R
authors.initials: WR
authors.lastname: Bosch
authors.affiliation: Stanford Cancer Institute, Stanford, California.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Chang
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Theodore S
authors.initials: TS
authors.lastname: Hong
authors.affiliation: Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
authors.forename: Salma K
authors.initials: SK
authors.lastname: Jabbour
authors.affiliation: Johns Hopkins Medical Center, Baltimore, Maryland.
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Kleinberg
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Harvey J
authors.initials: HJ
authors.lastname: Mamon
authors.affiliation: Knight Cancer Institute, Oregon Health & Sciences University, Portland, Oregon.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Thomas
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Karyn A
authors.initials: KA
authors.lastname: Goodman
mesh_terms: D000465:Algorithms; D032921:Consensus; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D004943:Esophagogastric Junction / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008488:Medical Illustration; D058958:Organs at Risk / Q000000981:diagnostic imaging / Q000528:radiation effects; D049268:Positron-Emission Tomography; D011832:Radiation Injuries / Q000517:prevention & control; D018787:Radiation Oncology; D050397:Radiotherapy, Intensity-Modulated; D014057:Tomography, X-Ray Computed / Q000379:methods; D047368:Tumor Burden