Impact of endorectal filling on interobserver variability of MRI based rectal primary tumor delineation
Background: Online adaptive MR-guided radiotherapy allows for the reduction of safety margins in dose escalated treatment of rectal tumors. With the use of smaller margins, precise tumor delineation becomes more critical. In the present study we investigated the impact of rectal ultrasound gel filli...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-01-01
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| Series: | Clinical and Translational Radiation Oncology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405630822000775 |
| _version_ | 1811201692730916864 |
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| author | Monica Lo Russo Marcel Nachbar Aisling Barry Shree Bhide Amy Chang William Hall Martijn Intven Corrie Marijnen Femke Peters Bruce Minsky Paul B. Romesser Reith Sarkar Alex Tan Simon Boeke Daniel Wegener Sarah Butzer Jessica Boldt Sergios Gatidis Konstantin Nikolaou Daniela Thorwarth Daniel Zips Cihan Gani |
| author_facet | Monica Lo Russo Marcel Nachbar Aisling Barry Shree Bhide Amy Chang William Hall Martijn Intven Corrie Marijnen Femke Peters Bruce Minsky Paul B. Romesser Reith Sarkar Alex Tan Simon Boeke Daniel Wegener Sarah Butzer Jessica Boldt Sergios Gatidis Konstantin Nikolaou Daniela Thorwarth Daniel Zips Cihan Gani |
| author_sort | Monica Lo Russo |
| collection | DOAJ |
| description | Background: Online adaptive MR-guided radiotherapy allows for the reduction of safety margins in dose escalated treatment of rectal tumors. With the use of smaller margins, precise tumor delineation becomes more critical. In the present study we investigated the impact of rectal ultrasound gel filling on interobserver variability in delineation of primary rectal tumor volumes. Methods: Six patients with locally advanced rectal cancer were scanned on a 1.5 T MRI-Linac without (MRI_e) and with application of 100 cc of ultrasound gel transanally (MRI_f). Eight international radiation oncologists expert in the treatment of gastrointestinal cancers delineated the gross tumor volume (GTV) on both MRI scans. MRI_f scans were provided to the participating centers after MRI_e scans had been returned. Interobserver variability was analyzed by either comparing the observers’ delineations with a reference delineation (approach 1) and by building all possible pairs between observers (approach 2). Dice Similarity Index (DICE) and 95 % Hausdorff-Distance (95 %HD) were calculated. Results: Rectal ultrasound gel filling was well tolerated by all patients. Overall, interobserver agreement was superior in MRI_f scans based on median DICE (0.81 vs 0.74, p < 0.005 for approach 1 and 0.76 vs 0.64, p < 0.0001 for approach 2) and 95 %HD (6.9 mm vs 4.2 mm for approach 1, p = 0.04 and 8.9 mm vs 6.1 mm, p = 0.04 for approach 2). Delineated median tumor volumes and inter-quartile ranges were 26.99 cc [18.01–50.34 cc] in MRI_e and 44.20 [19.72–61.59 cc] in MRI_f scans respectively, p = 0.012. Conclusions: Although limited by the small number of patients, in this study the application of rectal ultrasound gel resulted in higher interobserver agreement in rectal GTV delineation. The endorectal gel filling might be a useful tool for future dose escalation strategies. |
| first_indexed | 2024-04-12T02:25:57Z |
| format | Article |
| id | doaj.art-9e305c20923447fbb2481e74f4661011 |
| institution | Directory Open Access Journal |
| issn | 2405-6308 |
| language | English |
| last_indexed | 2024-04-12T02:25:57Z |
| publishDate | 2023-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical and Translational Radiation Oncology |
| spelling | doaj.art-9e305c20923447fbb2481e74f46610112022-12-22T03:52:00ZengElsevierClinical and Translational Radiation Oncology2405-63082023-01-013815Impact of endorectal filling on interobserver variability of MRI based rectal primary tumor delineationMonica Lo Russo0Marcel Nachbar1Aisling Barry2Shree Bhide3Amy Chang4William Hall5Martijn Intven6Corrie Marijnen7Femke Peters8Bruce Minsky9Paul B. Romesser10Reith Sarkar11Alex Tan12Simon Boeke13Daniel Wegener14Sarah Butzer15Jessica Boldt16Sergios Gatidis17Konstantin Nikolaou18Daniela Thorwarth19Daniel Zips20Cihan Gani21Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany; Corresponding author.Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, GermanyRadiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, CanadaRadiotherapy and Imaging, The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, United KingdomHong Kong Sanatorium and Hospital, Hong Kong, ChinaDepartment of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USADepartment of Radiation Oncology, University Medical Center Utrecht, Utrecht, The NetherlandsDepartment of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the NetherlandsDepartment of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the NetherlandsDepartment of Gastrointestinal Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USADepartment of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USADepartment of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USAGenesisCare, AustraliaDepartment of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, GermanyDepartment of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, GermanyDepartment of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, GermanyDepartment of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, GermanyDepartment of Radiology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, GermanyDepartment of Radiology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, GermanySection for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, Germany; German Cancer Research Center (DKFZ) Heidelberg and German Consortium for Translational Cancer Research (DKTK), Partner Site Tübingen, Tübingen, GermanyDepartment of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany; German Cancer Research Center (DKFZ) Heidelberg and German Consortium for Translational Cancer Research (DKTK), Partner Site Tübingen, Tübingen, GermanyDepartment of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany; German Cancer Research Center (DKFZ) Heidelberg and German Consortium for Translational Cancer Research (DKTK), Partner Site Tübingen, Tübingen, GermanyBackground: Online adaptive MR-guided radiotherapy allows for the reduction of safety margins in dose escalated treatment of rectal tumors. With the use of smaller margins, precise tumor delineation becomes more critical. In the present study we investigated the impact of rectal ultrasound gel filling on interobserver variability in delineation of primary rectal tumor volumes. Methods: Six patients with locally advanced rectal cancer were scanned on a 1.5 T MRI-Linac without (MRI_e) and with application of 100 cc of ultrasound gel transanally (MRI_f). Eight international radiation oncologists expert in the treatment of gastrointestinal cancers delineated the gross tumor volume (GTV) on both MRI scans. MRI_f scans were provided to the participating centers after MRI_e scans had been returned. Interobserver variability was analyzed by either comparing the observers’ delineations with a reference delineation (approach 1) and by building all possible pairs between observers (approach 2). Dice Similarity Index (DICE) and 95 % Hausdorff-Distance (95 %HD) were calculated. Results: Rectal ultrasound gel filling was well tolerated by all patients. Overall, interobserver agreement was superior in MRI_f scans based on median DICE (0.81 vs 0.74, p < 0.005 for approach 1 and 0.76 vs 0.64, p < 0.0001 for approach 2) and 95 %HD (6.9 mm vs 4.2 mm for approach 1, p = 0.04 and 8.9 mm vs 6.1 mm, p = 0.04 for approach 2). Delineated median tumor volumes and inter-quartile ranges were 26.99 cc [18.01–50.34 cc] in MRI_e and 44.20 [19.72–61.59 cc] in MRI_f scans respectively, p = 0.012. Conclusions: Although limited by the small number of patients, in this study the application of rectal ultrasound gel resulted in higher interobserver agreement in rectal GTV delineation. The endorectal gel filling might be a useful tool for future dose escalation strategies.http://www.sciencedirect.com/science/article/pii/S2405630822000775Rectal cancerMR-guided radiotherapyMRI-LinacInter-observer agreement |
| spellingShingle | Monica Lo Russo Marcel Nachbar Aisling Barry Shree Bhide Amy Chang William Hall Martijn Intven Corrie Marijnen Femke Peters Bruce Minsky Paul B. Romesser Reith Sarkar Alex Tan Simon Boeke Daniel Wegener Sarah Butzer Jessica Boldt Sergios Gatidis Konstantin Nikolaou Daniela Thorwarth Daniel Zips Cihan Gani Impact of endorectal filling on interobserver variability of MRI based rectal primary tumor delineation Clinical and Translational Radiation Oncology Rectal cancer MR-guided radiotherapy MRI-Linac Inter-observer agreement |
| title | Impact of endorectal filling on interobserver variability of MRI based rectal primary tumor delineation |
| title_full | Impact of endorectal filling on interobserver variability of MRI based rectal primary tumor delineation |
| title_fullStr | Impact of endorectal filling on interobserver variability of MRI based rectal primary tumor delineation |
| title_full_unstemmed | Impact of endorectal filling on interobserver variability of MRI based rectal primary tumor delineation |
| title_short | Impact of endorectal filling on interobserver variability of MRI based rectal primary tumor delineation |
| title_sort | impact of endorectal filling on interobserver variability of mri based rectal primary tumor delineation |
| topic | Rectal cancer MR-guided radiotherapy MRI-Linac Inter-observer agreement |
| url | http://www.sciencedirect.com/science/article/pii/S2405630822000775 |
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