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Title: External evaluation of the Radiation Therapy Oncology Group brachial plexus contouring protocol: several issues identified.
Authors: Min, Myo
Roos, Daniel
Keating, Elly
Penniment, Michael
Carruthers, Scott
Zanchetta, Lydia
Wong, Karen
Shakeshaft, John
Baxi, Siddhartha
Affiliation: Alan Walker Cancer Centre, Royal Darwin Hospital, Darwin, Northern Territory, Australia; Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia..
Issue Date: 2014
Citation: Journal of medical imaging and radiation oncology 2014; 58(3): 360-8
Abstract: The aims of the study were to evaluate interobserver variability in contouring the brachial plexus (BP) using the Radiation Therapy Oncology Group (RTOG)-approved protocol and to analyse BP dosimetries. Seven outliners independently contoured the BPs of 15 consecutive patients. Interobserver variability was reviewed qualitatively (visually by using planning axial computed-tomography images and anteroposterior digitally reconstructed radiographs) and quantitatively (by volumetric and statistical analyses). Dose-volume histograms of BPs were calculated and compared. We found significant interobserver variability among outliners in both qualitative and quantitative analyses. These were most pronounced for the T1 nerve roots on visual inspection and for the BP volume on statistical analysis. The BP volumes were smaller than those described in the RTOG atlas paper, with a mean volume of 20.8 cc (range 11-40.7 cc) compared with 33 ± 4 cc (25.1-39.4 cc). The average values of mean dose, maximum dose, V60Gy, V66Gy and V70Gy for patients treated with conventional radiotherapy and IMRT were 42.2 Gy versus 44.8 Gy, 64.5 Gy versus 68.5 Gy, 6.1% versus 7.6%, 2.9% versus 2.4% and 0.6% versus 0.3%, respectively. This is the first independent external evaluation of the published protocol. We have identified several issues, including significant interobserver variation. Although radiation oncologists should contour BPs to avoid dose dumping, especially when using IMRT, the RTOG atlas should be used with caution. Because BPs are largely radiologically occult on CT, we propose the term brachial-plexus regions (BPRs) to represent regions where BPs are likely to be present. Consequently, BPRs should in principle be contoured generously.
DOI: 10.1111/1754-9485.12175
Type: Clinical Trial
Historical Article
Journal Article
Subjects: Radiation Therapy Oncology Group protocol
brachial plexus
head and neck cancer
intensity-modulated radiotherapy
radiation-induced brachial plexopathy
Aged, 80 and over
Anatomic Landmarks
Brachial Plexus
Head and Neck Neoplasms
History, Ancient
Medical Oncology
Middle Aged
Observer Variation
Organ Sparing Treatments
Practice Guidelines as Topic
Radionuclide Imaging
Radiotherapy, Image-Guided
Reproducibility of Results
Sensitivity and Specificity
Tomography, X-Ray Computed
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