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Konopka-Filippow M, Sierko E, Hempel D, Maksim R, Samołyk-Kogaczewska N, Filipowski T, Rożkowska E, Jelski S, Kasprowicz B, Karbowska E, Szymański K, Szczecina K. The Learning Curve and Inter-Observer Variability in Contouring the Hippocampus under the Hippocampal Sparing Guidelines of Radiation Therapy Oncology Group 0933. Curr Oncol 2022; 29:2564-2574. [PMID: 35448184 PMCID: PMC9027685 DOI: 10.3390/curroncol29040210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/04/2022] [Indexed: 11/23/2022] Open
Abstract
Hippocampal-sparing brain radiotherapy (HS-BRT) in cancer patients results in preservation of neurocognitive function after brain RT which can contribute to patients’ quality of life (QoL). The crucial element in HS-BRT treatment planning is appropriate contouring of the hippocampus. Ten doctors delineated the left and right hippocampus (LH and RH, respectively) on 10 patients’ virtual axial images of brain CT fused with T1-enhanced MRI (1 mm) according to the RTOG 0933 atlas recommendations. Variations in the spatial localization of the structure were described in three directions: right–left (X), cranio-caudal (Y), and forward–backward (Z). Discrepancies concerned three-dimensional localization, shape, volume and size of the hippocampus. The largest differences were observed in the first three delineated cases which were characterized by larger hippocampal volumes than the remaining seven cases. The volumes of LH of more than half of hippocampus contours were marginally bigger than those of RH. Most differences in delineation of the hippocampus were observed in the area of the posterior horn of the lateral ventricle. Conversely, a large number of hippocampal contours overlapped near the brainstem and the anterior horn of the lateral ventricle. The most problematic area of hippocampal contouring is the posterior horn of the lateral ventricle. Training in the manual contouring of the hippocampus during HS-BRT treatment planning under the supervision of experienced radiation oncologists is necessary to achieve optimal outcomes. This would result in superior outcomes of HS-BRT treatment and improvement in QoL of patients compared to without HS-BRT procedure. Correct delineation of the hippocampus is problematic. This study demonstrates difficulties in HS-BRT treatment planning and highlights critical points during hippocampus delineation.
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Affiliation(s)
- Monika Konopka-Filippow
- Department of Oncology, Medical University of Bialystok, 15-089 Białystok, Poland; (M.K.-F.); (D.H.)
- Department of Radiotherapy I, Maria Sklodowska-Curie Bialystok Oncology Centre, 15-027 Białystok, Poland; (R.M.); (N.S.-K.); (T.F.); (E.R.)
| | - Ewa Sierko
- Department of Oncology, Medical University of Bialystok, 15-089 Białystok, Poland; (M.K.-F.); (D.H.)
- Department of Radiotherapy I, Maria Sklodowska-Curie Bialystok Oncology Centre, 15-027 Białystok, Poland; (R.M.); (N.S.-K.); (T.F.); (E.R.)
- Correspondence: ; Tel.: +48-85-6646734; Fax: +48-6646783
| | - Dominika Hempel
- Department of Oncology, Medical University of Bialystok, 15-089 Białystok, Poland; (M.K.-F.); (D.H.)
- Department of Radiotherapy I, Maria Sklodowska-Curie Bialystok Oncology Centre, 15-027 Białystok, Poland; (R.M.); (N.S.-K.); (T.F.); (E.R.)
| | - Rafał Maksim
- Department of Radiotherapy I, Maria Sklodowska-Curie Bialystok Oncology Centre, 15-027 Białystok, Poland; (R.M.); (N.S.-K.); (T.F.); (E.R.)
| | - Natalia Samołyk-Kogaczewska
- Department of Radiotherapy I, Maria Sklodowska-Curie Bialystok Oncology Centre, 15-027 Białystok, Poland; (R.M.); (N.S.-K.); (T.F.); (E.R.)
| | - Tomasz Filipowski
- Department of Radiotherapy I, Maria Sklodowska-Curie Bialystok Oncology Centre, 15-027 Białystok, Poland; (R.M.); (N.S.-K.); (T.F.); (E.R.)
| | - Ewa Rożkowska
- Department of Radiotherapy I, Maria Sklodowska-Curie Bialystok Oncology Centre, 15-027 Białystok, Poland; (R.M.); (N.S.-K.); (T.F.); (E.R.)
| | - Stefan Jelski
- Department of Radiology, Maria Sklodowska-Curie Bialystok Oncology Centre, 15-027 Białystok, Poland; (S.J.); (B.K.); (E.K.)
| | - Beata Kasprowicz
- Department of Radiology, Maria Sklodowska-Curie Bialystok Oncology Centre, 15-027 Białystok, Poland; (S.J.); (B.K.); (E.K.)
| | - Eryka Karbowska
- Department of Radiology, Maria Sklodowska-Curie Bialystok Oncology Centre, 15-027 Białystok, Poland; (S.J.); (B.K.); (E.K.)
| | - Krzysztof Szymański
- Department of Physics, University of Bialystok, 15-245 Białystok, Poland; (K.S.); (K.S.)
| | - Kamil Szczecina
- Department of Physics, University of Bialystok, 15-245 Białystok, Poland; (K.S.); (K.S.)
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Shimizu H, Sasaki K, Aoyama T, Tachibana H, Koide Y, Iwata T, Kitagawa T, Kodaira T. Parotid gland dose reduction in the hippocampus avoidance whole-brain radiotherapy using helical tomotherapy. JOURNAL OF RADIATION RESEARCH 2022; 63:55-62. [PMID: 34850078 PMCID: PMC8776702 DOI: 10.1093/jrr/rrab107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/27/2021] [Indexed: 06/13/2023]
Abstract
The present study aimed to reduce the parotid gland dose in the hippocampus avoidance with whole-brain radiotherapy (HA-WBRT) using the helical tomotherapy (HT). Ten patients who had previously undergone WBRT were randomly selected and enrolled in this study. During the treatment planning, two different techniques to the jaw were applied for each patient, namely, 1.0 cm fixed jaw and 2.5 cm dynamic jaw. To efficiently reduce the dose in the bilateral parotid glands, directional block (DB) mode was set. The DB is a function of a treatment planning system for the dose reduction in organs at risk. The standard HA-WBRT plan which did not reduce the parotid gland dose was also designed to compare the plan quality. Compared with the standard HA-WBRT plan, the parotid gland dose could be reduced by approximately 70% without extending the delivery time by adding the parotid gland on the DB mode to the dose constraint. In addition, the differences in dosimetric parameters observed between the plans employing the 1.0 cm fixed jaw and 2.5 cm dynamic jaw were almost negligible. Moreover, delivery time in the 2.5 cm dynamic jaw could be greatly reduced by 60% compared with that in the 1.0 cm fixed jaw.
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Affiliation(s)
- Hidetoshi Shimizu
- Corresponding Author. Department of Radiation Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Japan, Tel.: +81-52-762-6111, Fax: +81-52-752-8390;
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Bartel F, van Herk M, Vrenken H, Vandaele F, Sunaert S, de Jaeger K, Dollekamp NJ, Carbaat C, Lamers E, Dieleman EMT, Lievens Y, de Ruysscher D, Schagen SB, de Ruiter MB, de Munck JC, Belderbos J. Inter-observer variation of hippocampus delineation in hippocampal avoidance prophylactic cranial irradiation. Clin Transl Oncol 2018; 21:178-186. [PMID: 29876759 DOI: 10.1007/s12094-018-1903-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/24/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Hippocampal avoidance prophylactic cranial irradiation (HA-PCI) techniques have been developed to reduce radiation damage to the hippocampus. An inter-observer hippocampus delineation analysis was performed and the influence of the delineation variability on dose to the hippocampus was studied. MATERIALS AND METHODS For five patients, seven observers delineated both hippocampi on brain MRI. The intra-class correlation (ICC) with absolute agreement and the generalized conformity index (CIgen) were computed. Median surfaces over all observers' delineations were created for each patient and regional outlining differences were analysed. HA-PCI dose plans were made from the median surfaces and we investigated whether dose constraints in the hippocampus could be met for all delineations. RESULTS The ICC for the left and right hippocampus was 0.56 and 0.69, respectively, while the CIgen ranged from 0.55 to 0.70. The posterior and anterior-medial hippocampal regions had most variation with SDs ranging from approximately 1 to 2.5 mm. The mean dose (Dmean) constraint was met for all delineations, but for the dose received by 1% of the hippocampal volume (D1%) violations were observed. CONCLUSION The relatively low ICC and CIgen indicate that delineation variability among observers for both left and right hippocampus was large. The posterior and anterior-medial border have the largest delineation inaccuracy. The hippocampus Dmean constraint was not violated.
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Affiliation(s)
- F Bartel
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - M van Herk
- Department of Cancer Sciences, University of Manchester, Manchester, UK
| | - H Vrenken
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - F Vandaele
- Department of Radiotherapy, Iridium Cancer Network, Antwerp, Belgium
| | - S Sunaert
- Department of Radiology, University Hospitals Leuven, Louvain, Belgium
| | - K de Jaeger
- Department of Radiotherapy, Catharina Hospital, Eindhoven, The Netherlands
| | - N J Dollekamp
- Department of Radiotherapy, The University Medical Center Groningen, Groningen, The Netherlands
| | - C Carbaat
- Department of Radiotherapy, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - E Lamers
- Department of Radiotherapy, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - E M T Dieleman
- Department of Radiotherapy, Academic Medical Center, Amsterdam, The Netherlands
| | - Y Lievens
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - D de Ruysscher
- Department of Radiotherapy, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S B Schagen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M B de Ruiter
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J C de Munck
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - J Belderbos
- Department of Radiotherapy, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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