Proposal for the delineation of neoadjuvant target volumes in oesophageal cancer

Purpose: To define instructions for delineation of target volumes in the neoadjuvant setting in oesophageal cancer. Materials and methods: Radiation oncologists of five European centres participated in the following consensus process: [1] revision of published (MEDLINE) and national/institutional delineation guidelines; [2] first delineation round of five cases (patient 1-5) according to national/institutional guidelines; [3] consensus meeting to discuss the results of step 1 and 2, followed by a target volume delineation proposal; [4] circulation of proposed instructions for target volume delineation and atlas for feedback; [5] second delineation round of five new cases (patient 6-10) to peer review and validate (two additional centres) the agreed delineation guidelines and atlas; [6] final consensus on the delineation guidelines depicted in an atlas. Target volumes of the delineation rounds were compared between centres by Dice similarity coefficient (DSC) and maximum/mean undirected Hausdorff distances (H-max/H-mean). Results: In the first delineation round, the consistency between centres was moderate (CTVtotal: DSC = 0. 59-0.88; H-mean = 0.2-0.4 cm). Delineations in the second round were much more consistent. Lowest variability was obtained between centres participating in the consensus meeting (CTVtotal: DSC: p < 0.050 between rounds for patients 6/7/8/10; H-mean: p < 0.050 for patients 7/8/10), compared to validation centres (CTVtotal: DSC: p < 0.050 between validation and consensus meeting centres for patients 6/7/8; H-mean: p < 0.050 for patients 7/10). A proposal for delineation of target volumes and an atlas were generated. Conclusion: We proposed instructions for target volume delineation and an atlas for the neoadjuvant radiation treatment in oesophageal cancer. These will enable a more uniform delineation of patients in clinical practice and clinical trials. (C) 2020 Elsevier B.V. All rights reserved.

Automated summary

The study defined instructions for delineation of target volumes in neoadjuvant radiation treatment for esophageal cancer through a consensus process, generating an atlas for guidance. This will lead to more uniform delineation of patients in clinical practice and trials.