title: Consensus Recommendations for Radiation Therapy Contouring and Treatment of Vulvar Carcinoma.
abstract: The purpose of this study was to develop a radiation therapy (RT) contouring atlas and recommendations for women with postoperative and locally advanced vulvar carcinoma.
  
  
  
  An international committee of 35 expert gynecologic radiation oncologists completed a survey of the treatment of vulvar carcinoma. An initial set of recommendations for contouring was discussed and generated by consensus. Two cases, 1 locally advanced and 1 postoperative, were contoured by 14 physicians. Contours were compared and analyzed using an expectation-maximization algorithm for simultaneous truth and performance level estimation (STAPLE), and a 95% confidence interval contour was developed. The level of agreement among contours was assessed using a kappa statistic. STAPLE contours underwent full committee editing to generate the final atlas consensus contours.
  
  
  
  Analysis of the 14 contours showed substantial agreement, with kappa statistics of 0.69 and 0.64 for cases 1 and 2, respectively. There was high specificity for both cases (≥99%) and only moderate sensitivity of 71.3% and 64.9% for cases 1 and 2, respectively. Expert review and discussion generated consensus recommendations for contouring target volumes and treatment for postoperative and locally advanced vulvar cancer.
  
  
  
  These consensus recommendations for contouring and treatment of vulvar cancer identified areas of complexity and controversy. Given the lack of clinical research evidence in vulvar cancer radiation therapy, the committee advocates a conservative and consistent approach using standardized recommendations.
authors.affiliation: Department of Radiation Oncology, Huntsman Cancer Hospital, Salt Lake City, Utah. Electronic address: david.gaffney@hci.utah.edu.
authors.forename: David K
authors.initials: DK
authors.lastname: Gaffney
authors.affiliation: Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre and Epworth Radiation Oncology, Melbourne, Victoria, Australia.
authors.forename: Bronwyn
authors.initials: B
authors.lastname: King
authors.affiliation: Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Akila N
authors.initials: AN
authors.lastname: Viswanathan
authors.affiliation: Department of Radiation Oncology, Centre hospitalier de l'universite de Montreal, Montreal, Quebec, Canada.
authors.forename: Maroie
authors.initials: M
authors.lastname: Barkati
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
authors.forename: Sushil
authors.initials: S
authors.lastname: Beriwal
authors.affiliation: Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Patricia
authors.initials: P
authors.lastname: Eifel
authors.affiliation: Department of Radiation Oncology, Proedtert and Medical College Clinical Cancer Center, Milwaukee, Wisconsin.
authors.forename: Beth
authors.initials: B
authors.lastname: Erickson
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Fyles
authors.affiliation: Department of Radiation Oncology, British Columbia Cancer Agency, Victoria, British Columbia, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Goulart
authors.affiliation: Department of Radiation Oncology, Stritch School of Medicine, Loyola University, Maywood, Illinois.
authors.forename: Matthew
authors.initials: M
authors.lastname: Harkenrider
authors.affiliation: Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Anuja
authors.initials: A
authors.lastname: Jhingran
authors.affiliation: Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Ann
authors.initials: A
authors.lastname: Klopp
authors.affiliation: Department of Radiation Oncology, University of Washington, Seattle, Washington.
authors.forename: Wui-Jin
authors.initials: WJ
authors.lastname: Koh
authors.affiliation: Liverpool Cancer Therapy Centre, Radiation Oncology Unit, Sydney, New South Wales, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Lim
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ivy
authors.initials: I
authors.lastname: Petersen
authors.affiliation: Radiation Oncology Department, Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Portelance
authors.affiliation: Department of Radiation Oncology, Stritch School of Medicine, Loyola University, Maywood, Illinois.
authors.forename: William
authors.initials: W
authors.lastname: Small
authors.affiliation: St. Luke's Cancer Centre, Royal Surrey Country Hospital, Surrey, United Kingdom.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Stewart
authors.affiliation: Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada.
authors.forename: Ericka
authors.initials: E
authors.lastname: Wiebe
authors.affiliation: Radiation Oncology Department, Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: Aaron
authors.initials: A
authors.lastname: Wolfson
authors.affiliation: Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California.
authors.forename: Catheryn
authors.initials: C
authors.lastname: Yashar
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Walter
authors.initials: W
authors.lastname: Bosch
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D056888:Patient Positioning; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D047368:Tumor Burden; D014621:Vagina / Q000473:pathology; D014846:Vulvar Neoplasms / Q000473:pathology / Q000532:radiotherapy*