Variation in clinical target volume delineation in postoperative radiotherapy for biliary tract cancer

We aimed to evaluate the inter-clinician variability in the clinical target volume (CTV) for postoperative radiotherapy (PORT) for biliary tract cancer (BTC) including extrahepatic bile duct cancer (EBDC) and gallbladder cancer (GBC). Nine experienced radiation oncologists delineated PORT CTVs for d...

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Bibliographic Details
Published in:PloS one 2022-09, Vol.17 (9), p.e0273395-e0273395
Main Authors: Koo, Taeryool, Cheong, Kwang-Ho, Kim, Kyubo, Park, Hae Jin, Park, Younghee, Koh, Hyeon Kang, Kim, Byoung Hyuck, Kim, Eunji, Kim, Kyung Su, Choi, Jin Hwa
Format: Article
Language:English
Subjects:
Algorithms
Auroral kilometric radiation
Bile ducts
Biliary tract
Borders
Cancer
Cancer therapies
Cholangiocarcinoma
Cholecystectomy
Complications and side effects
Confidence intervals
Gallbladder
Gallbladder cancer
Lymph nodes
Medical prognosis
Medicine and Health Sciences
Metastasis
Pancreatic cancer
Pancreaticoduodenectomy
Patient outcomes
Patients
Radiation
Radiation therapy
Radiotherapy
Variability
Variation
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Summary:We aimed to evaluate the inter-clinician variability in the clinical target volume (CTV) for postoperative radiotherapy (PORT) for biliary tract cancer (BTC) including extrahepatic bile duct cancer (EBDC) and gallbladder cancer (GBC). Nine experienced radiation oncologists delineated PORT CTVs for distal EBDC (pT2N1), proximal EBDC (pT2bN1) and GBC (pT2bN1) patients. The expectation maximization algorithm for Simultaneous Truth and Performance Level Estimation (STAPLE) was used to quantify expert agreements. We generated volumes with a confidence level of 80% to compare the maximum distance to each CTV in six directions. The degree of agreement was moderate; overall kappa values were 0.573 for distal EBDC, 0.513 for proximal EBDC, and 0.511 for GBC. In the distal EBDC, a larger variation was noted in the right, post, and inferior direction. In the proximal EBDC, all borders except the right and left direction showed a larger variation. In the GBC, a larger variation was found in the anterior, posterior, and inferior direction. The posterior and inferior borders were the common area having discrepancies, associated with the insufficient coverage of the paraaortic node. A consensus guideline is needed to reduce inter-clinician variability in the CTVs and adequate coverage of regional lymph node area.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0273395