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Published in: Strahlentherapie und Onkologie 6/2015

01-06-2015 | Original Article

A teaching intervention in a contouring dummy run improved target volume delineation in locally advanced non-small cell lung cancer

Reducing the interobserver variability in multicentre clinical studies

Authors: Tanja Schimek-Jasch, M.D., Esther G. C. Troost, M.D., Ph.D., Gerta Rücker, Ph.D., Vesna Prokic, Ph.D., Melanie Avlar, Viola Duncker-Rohr, M.D., Michael Mix, Ph.D., Christian Doll, M.D., Anca-Ligia Grosu, M.D., Ph.D., Ursula Nestle, M.D., Ph.D.

Published in: Strahlentherapie und Onkologie | Issue 6/2015

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Abstract

Introduction

Interobserver variability in the definition of target volumes (TVs) is a well-known confounding factor in (multicentre) clinical studies employing radiotherapy. Therefore, detailed contouring guidelines are provided in the prospective randomised multicentre PET-Plan (NCT00697333) clinical trial protocol. This trial compares strictly FDG-PET-based TV delineation with conventional TV delineation in patients with locally advanced non-small cell lung cancer (NSCLC). Despite detailed contouring guidelines, their interpretation by different radiation oncologists can vary considerably, leading to undesirable discrepancies in TV delineation. Considering this, as part of the PET-Plan study quality assurance (QA), a contouring dummy run (DR) consisting of two phases was performed to analyse the interobserver variability before and after teaching.

Materials and methods

In the first phase of the DR (DR1), radiation oncologists from 14 study centres were asked to delineate TVs as defined by the study protocol (gross TV, GTV; and two clinical TVs, CTV-A and CTV-B) in a test patient. A teaching session was held at a study group meeting, including a discussion of the results focussing on discordances in comparison to the per-protocol solution. Subsequently, the second phase of the DR (DR2) was performed in order to evaluate the impact of teaching.

Results

Teaching after DR1 resulted in a reduction of absolute TVs in DR2, as well as in better concordance of TVs. The Overall Kappa(κ) indices increased from 0.63 to 0.71 (GTV), 0.60 to 0.65 (CTV-A) and from 0.59 to 0.63 (CTV-B), demonstrating improvements in overall interobserver agreement.

Conclusion

Contouring DRs and study group meetings as part of QA in multicentre clinical trials help to identify misinterpretations of per-protocol TV delineation. Teaching the correct interpretation of protocol contouring guidelines leads to a reduction in interobserver variability and to more consistent contouring, which should consequently improve the validity of the overall study results.
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Literature
1.
go back to reference WHO (2014) World Health Organization. World cancer factsheet January 2014: world cancer burden (2012). Accessed 6 Nov. 2014 WHO (2014) World Health Organization. World cancer factsheet January 2014: world cancer burden (2012). Accessed 6 Nov. 2014
2.
go back to reference Auperin A, Le Pechoux C, Rolland E, Curran WJ, Furuse K, Fournel P, Belderbos J, Clamon G, Ulutin HC, Paulus R, Yamanaka T, Bozonnat MC, Uitterhoeve A, Wang X, Stewart L, Arriagada R, Burdett S, Pignon JP (2010) Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced non-small-cell lung cancer. J Clin Oncol 28:2181–2190. doi:10.1200/JCO.2009.26.2543CrossRefPubMed Auperin A, Le Pechoux C, Rolland E, Curran WJ, Furuse K, Fournel P, Belderbos J, Clamon G, Ulutin HC, Paulus R, Yamanaka T, Bozonnat MC, Uitterhoeve A, Wang X, Stewart L, Arriagada R, Burdett S, Pignon JP (2010) Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced non-small-cell lung cancer. J Clin Oncol 28:2181–2190. doi:10.1200/JCO.2009.26.2543CrossRefPubMed
3.
go back to reference Goeckenjan G, Sitter H, Thomas M, Branscheid D, Flentje M, Griesinger F, Niederle N, Stuschke M, Blum T, Deppermann KM, Ficker JH, Freitag L, Lubbe AS, Reinhold T, Spath-Schwalbe E, Ukena D, Wickert M, Wolf M, Andreas S, Auberger T, Baum RP, Baysal B, Beuth J, Bickeboller H, Bocking A, Bohle RM, Bruske I, Burghuber O, Dickgreber N, Diederich S, Dienemann H, Eberhardt W, Eggeling S, Fink T, Fischer B, Franke M, Friedel G, Gauler T, Gutz S, Hautmann H, Hellmann A, Hellwig D, Herth F, Heussel CP, Hilbe W, Hoffmeyer F, Horneber M, Huber RM, Hubner J, Kauczor HU, Kirchbacher K, Kirsten D, Kraus T, Lang SM, Martens U, Mohn-Staudner A, Muller KM, Muller-Nordhorn J, Nowak D, Ochmann U, Passlick B, Petersen I, Pirker R, Pokrajac B, Reck M, Riha S, Rube C, Schmittel A, Schonfeld N, Schutte W, Serke M, Stamatis G, Steingraber M, Steins M, Stoelben E, Swoboda L, Teschler H, Tessen HW, Weber M, Werner A, Wichmann HE, Irlinger Wimmer E, Witt C, Worth H, German Respiratory S, German Cancer S (2011) Prevention, diagnosis, therapy, and follow-up of lung cancer: interdisciplinary guideline of the German Respiratory Society and the German Cancer Society. Pneumologie 65:39–59. doi:10.1055/s-0030-1255961CrossRefPubMed Goeckenjan G, Sitter H, Thomas M, Branscheid D, Flentje M, Griesinger F, Niederle N, Stuschke M, Blum T, Deppermann KM, Ficker JH, Freitag L, Lubbe AS, Reinhold T, Spath-Schwalbe E, Ukena D, Wickert M, Wolf M, Andreas S, Auberger T, Baum RP, Baysal B, Beuth J, Bickeboller H, Bocking A, Bohle RM, Bruske I, Burghuber O, Dickgreber N, Diederich S, Dienemann H, Eberhardt W, Eggeling S, Fink T, Fischer B, Franke M, Friedel G, Gauler T, Gutz S, Hautmann H, Hellmann A, Hellwig D, Herth F, Heussel CP, Hilbe W, Hoffmeyer F, Horneber M, Huber RM, Hubner J, Kauczor HU, Kirchbacher K, Kirsten D, Kraus T, Lang SM, Martens U, Mohn-Staudner A, Muller KM, Muller-Nordhorn J, Nowak D, Ochmann U, Passlick B, Petersen I, Pirker R, Pokrajac B, Reck M, Riha S, Rube C, Schmittel A, Schonfeld N, Schutte W, Serke M, Stamatis G, Steingraber M, Steins M, Stoelben E, Swoboda L, Teschler H, Tessen HW, Weber M, Werner A, Wichmann HE, Irlinger Wimmer E, Witt C, Worth H, German Respiratory S, German Cancer S (2011) Prevention, diagnosis, therapy, and follow-up of lung cancer: interdisciplinary guideline of the German Respiratory Society and the German Cancer Society. Pneumologie 65:39–59. doi:10.1055/s-0030-1255961CrossRefPubMed
4.
go back to reference Fleckenstein J, Hellwig D, Kremp S, Grgic A, Groschel A, Kirsch CM, Nestle U, Rube C (2011) F-18-FDG-PET confined radiotherapy of locally advanced NSCLC with concomitant chemotherapy: results of the PET-PLAN pilot trial. International journal of radiation oncology, biology, physics. 81:e283–e289. doi:10.1016/j.ijrobp.2011.01.020 Fleckenstein J, Hellwig D, Kremp S, Grgic A, Groschel A, Kirsch CM, Nestle U, Rube C (2011) F-18-FDG-PET confined radiotherapy of locally advanced NSCLC with concomitant chemotherapy: results of the PET-PLAN pilot trial. International journal of radiation oncology, biology, physics. 81:e283–e289. doi:10.1016/j.ijrobp.2011.01.020
5.
go back to reference van Baardwijk A, Wanders S, Boersma L, Borger J, Ollers M, Dingemans AM, Bootsma G, Geraedts W, Pitz C, Lunde R, Lambin P, De Ruysscher D (2010) Mature results of an individualized radiation dose prescription study based on normal tissue constraints in stages I to III non-small-cell lung cancer. J Clin Oncol 28:1380–1386. doi:10.1200/JCO.2009.24.7221CrossRefPubMed van Baardwijk A, Wanders S, Boersma L, Borger J, Ollers M, Dingemans AM, Bootsma G, Geraedts W, Pitz C, Lunde R, Lambin P, De Ruysscher D (2010) Mature results of an individualized radiation dose prescription study based on normal tissue constraints in stages I to III non-small-cell lung cancer. J Clin Oncol 28:1380–1386. doi:10.1200/JCO.2009.24.7221CrossRefPubMed
6.
go back to reference Hoffmann AL, Troost EG, Huizenga H, Kaanders JH, Bussink J (2012) Individualized dose prescription for hypofractionation in advanced non-small-cell lung cancer radiotherapy: an in silico trial. International journal of radiation oncology, biology, physics. Int J Radiat Oncol Biol Phys 83:1596–1602. doi:10.1016/j.ijrobp.2011.10.032CrossRefPubMed Hoffmann AL, Troost EG, Huizenga H, Kaanders JH, Bussink J (2012) Individualized dose prescription for hypofractionation in advanced non-small-cell lung cancer radiotherapy: an in silico trial. International journal of radiation oncology, biology, physics. Int J Radiat Oncol Biol Phys 83:1596–1602. doi:10.1016/j.ijrobp.2011.10.032CrossRefPubMed
7.
go back to reference van Elmpt W, De Ruysscher D, van der Salm A, Lakeman A, van der Stoep J, Emans D, Damen E, Ollers M, Sonke JJ, Belderbos J (2012) The PET-boost randomised phase II dose-escalation trial in non-small cell lung cancer. Radiother Oncol 104:67–71. doi:10.1016/j.radonc.2012.03.005CrossRefPubMed van Elmpt W, De Ruysscher D, van der Salm A, Lakeman A, van der Stoep J, Emans D, Damen E, Ollers M, Sonke JJ, Belderbos J (2012) The PET-boost randomised phase II dose-escalation trial in non-small cell lung cancer. Radiother Oncol 104:67–71. doi:10.1016/j.radonc.2012.03.005CrossRefPubMed
8.
go back to reference Nestle U, Kremp S, Grosu AL (2006) Practical integration of [18F]-FDG-PET and PET-CT in the planning of radiotherapy for non-small cell lung cancer (NSCLC): the technical basis, ICRU-target volumes, problems, perspectives. Radiother Oncol 81:209–225. doi:10.1016/j.radonc.2006.09.011CrossRefPubMed Nestle U, Kremp S, Grosu AL (2006) Practical integration of [18F]-FDG-PET and PET-CT in the planning of radiotherapy for non-small cell lung cancer (NSCLC): the technical basis, ICRU-target volumes, problems, perspectives. Radiother Oncol 81:209–225. doi:10.1016/j.radonc.2006.09.011CrossRefPubMed
9.
go back to reference MacManus M, Nestle U, Rosenzweig KE, Carrio I, Messa C, Belohlavek O, Danna M, Inoue T, Deniaud-Alexandre E, Schipani S, Watanabe N, Dondi M, Jeremic B (2009) Use of PET and PET/CT for radiation therapy planning: IAEA expert report 2006–2007. Radiother Oncol 91:85–94. doi:10.1016/j.radonc.2008.11.008CrossRefPubMed MacManus M, Nestle U, Rosenzweig KE, Carrio I, Messa C, Belohlavek O, Danna M, Inoue T, Deniaud-Alexandre E, Schipani S, Watanabe N, Dondi M, Jeremic B (2009) Use of PET and PET/CT for radiation therapy planning: IAEA expert report 2006–2007. Radiother Oncol 91:85–94. doi:10.1016/j.radonc.2008.11.008CrossRefPubMed
10.
go back to reference Belderbos JS, Heemsbergen WD, De Jaeger K, Baas P, Lebesque JV (2006) Final results of a Phase I/II dose escalation trial in non-small-cell lung cancer using three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 66:126–134. doi:10.1016/j.ijrobp.2006.04.034CrossRefPubMed Belderbos JS, Heemsbergen WD, De Jaeger K, Baas P, Lebesque JV (2006) Final results of a Phase I/II dose escalation trial in non-small-cell lung cancer using three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 66:126–134. doi:10.1016/j.ijrobp.2006.04.034CrossRefPubMed
11.
go back to reference De Ruysscher D, Wanders S, van Haren E, Hochstenbag M, Geeraedts W, Utama I, Simons J, Dohmen J, Rhami A, Buell U, Thimister P, Snoep G, Boersma L, Verschueren T, van Baardwijk A, Minken A, Bentzen SM, Lambin P (2005) Selective mediastinal node irradiation based on FDG-PET scan data in patients with non-small-cell lung cancer: a prospective clinical study. Int J Radiat Oncol Biol Phys 62:988–994. doi:10.1016/j.ijrobp.2004.12.019CrossRefPubMed De Ruysscher D, Wanders S, van Haren E, Hochstenbag M, Geeraedts W, Utama I, Simons J, Dohmen J, Rhami A, Buell U, Thimister P, Snoep G, Boersma L, Verschueren T, van Baardwijk A, Minken A, Bentzen SM, Lambin P (2005) Selective mediastinal node irradiation based on FDG-PET scan data in patients with non-small-cell lung cancer: a prospective clinical study. Int J Radiat Oncol Biol Phys 62:988–994. doi:10.1016/j.ijrobp.2004.12.019CrossRefPubMed
12.
go back to reference Caldwell CB, Mah K, Ung YC, Danjoux CE, Balogh JM, Ganguli SN, Ehrlich LE (2001) Observer variation in contouring gross tumor volume in patients with poorly defined non-small-cell lung tumors on CT: the impact of 18FDG-hybrid PET fusion. Int J Radiat Oncol Biol Phys 51:923–931CrossRefPubMed Caldwell CB, Mah K, Ung YC, Danjoux CE, Balogh JM, Ganguli SN, Ehrlich LE (2001) Observer variation in contouring gross tumor volume in patients with poorly defined non-small-cell lung tumors on CT: the impact of 18FDG-hybrid PET fusion. Int J Radiat Oncol Biol Phys 51:923–931CrossRefPubMed
13.
go back to reference Nestle U, Weber W, Hentschel M, Grosu AL (2009) Biological imaging in radiation therapy: role of positron emission tomography. Phys Med Biol 54:R1–R25. doi:10.1088/0031-9155/54/1/R01CrossRefPubMed Nestle U, Weber W, Hentschel M, Grosu AL (2009) Biological imaging in radiation therapy: role of positron emission tomography. Phys Med Biol 54:R1–R25. doi:10.1088/0031-9155/54/1/R01CrossRefPubMed
14.
go back to reference Steenbakkers RJ, Duppen JC, Fitton I, Deurloo KE, Zijp LJ, Comans EF, Uitterhoeve AL, Rodrigus PT, Kramer GW, Bussink J, De Jaeger K, Belderbos JS, Nowak PJ, van Herk M, Rasch CR (2006) Reduction of observer variation using matched CT-PET for lung cancer delineation: a three-dimensional analysis. Int J Radiat Oncol Biol Phys 64:435–448. doi:10.1016/j.ijrobp.2005.06.034CrossRefPubMed Steenbakkers RJ, Duppen JC, Fitton I, Deurloo KE, Zijp LJ, Comans EF, Uitterhoeve AL, Rodrigus PT, Kramer GW, Bussink J, De Jaeger K, Belderbos JS, Nowak PJ, van Herk M, Rasch CR (2006) Reduction of observer variation using matched CT-PET for lung cancer delineation: a three-dimensional analysis. Int J Radiat Oncol Biol Phys 64:435–448. doi:10.1016/j.ijrobp.2005.06.034CrossRefPubMed
15.
go back to reference Nestle U, Mix M, Weber W, Grosu AL (2011) Klinische Studien zum Einsatz der PET in der Bestrahlungsplanung in Deutschland: Ein Update. Nuklearmediziner 34:130–132. doi:10.1055/s-0031-1280790CrossRef Nestle U, Mix M, Weber W, Grosu AL (2011) Klinische Studien zum Einsatz der PET in der Bestrahlungsplanung in Deutschland: Ein Update. Nuklearmediziner 34:130–132. doi:10.1055/s-0031-1280790CrossRef
16.
go back to reference Schimek-Jasch T, Küsters A, Hoffmans H, Nestle U (2014) Optimierung der Strahlentherapieplanung bei lokal fortgeschrittenen NSCLC durch 18F-FDG PET-CT: Stand der PET-Plan-Studie. Nuklearmediziner 37:175–180. doi:10.1055/s-0034-1376972CrossRef Schimek-Jasch T, Küsters A, Hoffmans H, Nestle U (2014) Optimierung der Strahlentherapieplanung bei lokal fortgeschrittenen NSCLC durch 18F-FDG PET-CT: Stand der PET-Plan-Studie. Nuklearmediziner 37:175–180. doi:10.1055/s-0034-1376972CrossRef
17.
go back to reference Djarv E, Nyman J, Baumann P, Ekberg L, Hoyer M, Lax I, Lewensohn R, Levin N, Lund JA, Morhed E, Ericsson SR, Traberg A, Wittgren L, Johansson KA (2006) Dummy run for a phase II study of stereotactic body radiotherapy of T1-T2 N0M0 medical inoperable non-small cell lung cancer. Acta Oncol 45:973–977. doi:10.1080/02841860600919241CrossRefPubMed Djarv E, Nyman J, Baumann P, Ekberg L, Hoyer M, Lax I, Lewensohn R, Levin N, Lund JA, Morhed E, Ericsson SR, Traberg A, Wittgren L, Johansson KA (2006) Dummy run for a phase II study of stereotactic body radiotherapy of T1-T2 N0M0 medical inoperable non-small cell lung cancer. Acta Oncol 45:973–977. doi:10.1080/02841860600919241CrossRefPubMed
18.
go back to reference Foppiano F, Fiorino C, Frezza G, Greco C, Valdagni R, Radiotherapy ANWGoP (2003) The impact of contouring uncertainty on rectal 3D dose-volume data: results of a dummy run in a multicenter trial (AIROPROS01-02). Int J Radiat Oncol Biol Phys 57:573–579CrossRefPubMed Foppiano F, Fiorino C, Frezza G, Greco C, Valdagni R, Radiotherapy ANWGoP (2003) The impact of contouring uncertainty on rectal 3D dose-volume data: results of a dummy run in a multicenter trial (AIROPROS01-02). Int J Radiat Oncol Biol Phys 57:573–579CrossRefPubMed
19.
go back to reference Giraud P, Elles S, Helfre S, De Rycke Y, Servois V, Carette MF, Alzieu C, Bondiau PY, Dubray B, Touboul E, Housset M, Rosenwald JC, Cosset JM (2002) Conformal radiotherapy for lung cancer: different delineation of the gross tumor volume (GTV) by radiologists and radiation oncologists. Radiother Oncol 62:27–36CrossRefPubMed Giraud P, Elles S, Helfre S, De Rycke Y, Servois V, Carette MF, Alzieu C, Bondiau PY, Dubray B, Touboul E, Housset M, Rosenwald JC, Cosset JM (2002) Conformal radiotherapy for lung cancer: different delineation of the gross tumor volume (GTV) by radiologists and radiation oncologists. Radiother Oncol 62:27–36CrossRefPubMed
20.
go back to reference Matzinger O, Poortmans P, Giraud JY, Maingon P, Budiharto T, van den Bergh AC, Davis JB, Musat E, Ataman F, Huyskens DP, Gulyban A, Bolla M, Group ERO (2009) Quality assurance in the 22991 EORTC ROG trial in localized prostate cancer: dummy run and individual case review. Radiother Oncol 90:285–290. doi:10.1016/j.radonc.2008.10.022CrossRefPubMed Matzinger O, Poortmans P, Giraud JY, Maingon P, Budiharto T, van den Bergh AC, Davis JB, Musat E, Ataman F, Huyskens DP, Gulyban A, Bolla M, Group ERO (2009) Quality assurance in the 22991 EORTC ROG trial in localized prostate cancer: dummy run and individual case review. Radiother Oncol 90:285–290. doi:10.1016/j.radonc.2008.10.022CrossRefPubMed
21.
go back to reference Poortmans PM, Venselaar JL, Struikmans H, Hurkmans CW, Davis JB, Huyskens D, van Tienhoven G, Vlaun V, Lagendijk JJ, Mijnheer BJ, De Winter KA, Van der Hulst MH, Van den Bogaert WF (2001) The potential impact of treatment variations on the results of radiotherapy of the internal mammary lymph node chain: a quality-assurance report on the dummy run of EORTC Phase III randomized trial 22922/10925 in Stage I-III breast cancer(1). Int J Radiat Oncol Biol Phys 49:1399–1408CrossRefPubMed Poortmans PM, Venselaar JL, Struikmans H, Hurkmans CW, Davis JB, Huyskens D, van Tienhoven G, Vlaun V, Lagendijk JJ, Mijnheer BJ, De Winter KA, Van der Hulst MH, Van den Bogaert WF (2001) The potential impact of treatment variations on the results of radiotherapy of the internal mammary lymph node chain: a quality-assurance report on the dummy run of EORTC Phase III randomized trial 22922/10925 in Stage I-III breast cancer(1). Int J Radiat Oncol Biol Phys 49:1399–1408CrossRefPubMed
22.
go back to reference Spoelstra FO, Senan S, Le Pechoux C, Ishikura S, Casas F, Ball D, Price A, De Ruysscher D, van Sornsen de Koste JR, Lung Adjuvant Radiotherapy Trial Investigators G (2010) Variations in target volume definition for postoperative radiotherapy in stage III non-small-cell lung cancer: analysis of an international contouring study. Int J Radiat Oncol Biol Phys 76:1106–1113. doi:10.1016/j.ijrobp.2009.02.072 Spoelstra FO, Senan S, Le Pechoux C, Ishikura S, Casas F, Ball D, Price A, De Ruysscher D, van Sornsen de Koste JR, Lung Adjuvant Radiotherapy Trial Investigators G (2010) Variations in target volume definition for postoperative radiotherapy in stage III non-small-cell lung cancer: analysis of an international contouring study. Int J Radiat Oncol Biol Phys 76:1106–1113. doi:10.1016/j.ijrobp.2009.02.072
23.
go back to reference Senan S, van Sornsen de Koste J, Samson M, Tankink H, Jansen P, Nowak PJ, Krol AD, Schmitz P, Lagerwaard FJ (1999) Evaluation of a target contouring protocol for 3D conformal radiotherapy in non-small cell lung cancer. Radiother Oncol 53:247–255CrossRefPubMed Senan S, van Sornsen de Koste J, Samson M, Tankink H, Jansen P, Nowak PJ, Krol AD, Schmitz P, Lagerwaard FJ (1999) Evaluation of a target contouring protocol for 3D conformal radiotherapy in non-small cell lung cancer. Radiother Oncol 53:247–255CrossRefPubMed
24.
go back to reference Senan S, Le Pechoux C, Spoelstra FO, Ishikura S, Casas F, Ball D, Price A, De Ruysscher D, van Sörnsen de Koste JR (2007) A need to standardize post-operative radiotherapy (PORT) fields used for non-small cell lung cancer (NSCLC): analysis of an international dummy-run study: A1–02. J Thorac Oncol 2:S308–S309CrossRef Senan S, Le Pechoux C, Spoelstra FO, Ishikura S, Casas F, Ball D, Price A, De Ruysscher D, van Sörnsen de Koste JR (2007) A need to standardize post-operative radiotherapy (PORT) fields used for non-small cell lung cancer (NSCLC): analysis of an international dummy-run study: A1–02. J Thorac Oncol 2:S308–S309CrossRef
25.
go back to reference Valley JF, Bernier J, Tercier PA, Fogliata-Cozzi A, Rosset A, Garavaglia G, Mirimanoff RO (1998) Quality assurance of the EORTC radiotherapy trial 22931 for head and neck carcinomas: the dummy run. Radiother Oncol 47:37–44CrossRefPubMed Valley JF, Bernier J, Tercier PA, Fogliata-Cozzi A, Rosset A, Garavaglia G, Mirimanoff RO (1998) Quality assurance of the EORTC radiotherapy trial 22931 for head and neck carcinomas: the dummy run. Radiother Oncol 47:37–44CrossRefPubMed
26.
go back to reference Van de Steene J, Linthout N, de Mey J, Vinh-Hung V, Claassens C, Noppen M, Bel A, Storme G (2002) Definition of gross tumor volume in lung cancer: inter-observer variability. Radiother Oncol 62:37–49CrossRef Van de Steene J, Linthout N, de Mey J, Vinh-Hung V, Claassens C, Noppen M, Bel A, Storme G (2002) Definition of gross tumor volume in lung cancer: inter-observer variability. Radiother Oncol 62:37–49CrossRef
27.
go back to reference Vorwerk H, Beckmann G, Bremer M, Degen M, Dietl B, Fietkau R, Gsanger T, Hermann RM, Alfred Herrmann MK, Holler U, van Kampen M, Korber W, Maier B, Martin T, Metz M, Richter R, Siekmeyer B, Steder M, Wagner D, Hess CF, Weiss E, Christiansen H (2009) The delineation of target volumes for radiotherapy of lung cancer patients. Radiother Oncol 91:455–460. doi:10.1016/j.radonc.2009.03.014CrossRefPubMed Vorwerk H, Beckmann G, Bremer M, Degen M, Dietl B, Fietkau R, Gsanger T, Hermann RM, Alfred Herrmann MK, Holler U, van Kampen M, Korber W, Maier B, Martin T, Metz M, Richter R, Siekmeyer B, Steder M, Wagner D, Hess CF, Weiss E, Christiansen H (2009) The delineation of target volumes for radiotherapy of lung cancer patients. Radiother Oncol 91:455–460. doi:10.1016/j.radonc.2009.03.014CrossRefPubMed
28.
go back to reference Schaefer A, Nestle U, Kremp S, Hellwig D, Grgic A, Buchholz HG, Mischke W, Gromoll C, Dennert P, Plotkin M, Senftleben S, Thorwarth D, Tosch M, Wahl A, Wengenmair H, Rube C, Kirsch CM (2012) Multi-centre calibration of an adaptive thresholding method for PET-based delineation of tumour volumes in radiotherapy planning of lung cancer. Nuklearmedizin 51:101–110. doi:10.3413/Nukmed-0452-11-12CrossRefPubMed Schaefer A, Nestle U, Kremp S, Hellwig D, Grgic A, Buchholz HG, Mischke W, Gromoll C, Dennert P, Plotkin M, Senftleben S, Thorwarth D, Tosch M, Wahl A, Wengenmair H, Rube C, Kirsch CM (2012) Multi-centre calibration of an adaptive thresholding method for PET-based delineation of tumour volumes in radiotherapy planning of lung cancer. Nuklearmedizin 51:101–110. doi:10.3413/Nukmed-0452-11-12CrossRefPubMed
29.
go back to reference Schaefer A, Kremp S, Hellwig D, Rube C, Kirsch CM, Nestle U (2008) A contrast-oriented algorithm for FDG-PET-based delineation of tumour volumes for the radiotherapy of lung cancer: derivation from phantom measurements and validation in patient data. Eur J Nucl Med Mol Imaging 35:1989–1999. doi:10.1007/s00259-008-0875-1CrossRefPubMed Schaefer A, Kremp S, Hellwig D, Rube C, Kirsch CM, Nestle U (2008) A contrast-oriented algorithm for FDG-PET-based delineation of tumour volumes for the radiotherapy of lung cancer: derivation from phantom measurements and validation in patient data. Eur J Nucl Med Mol Imaging 35:1989–1999. doi:10.1007/s00259-008-0875-1CrossRefPubMed
30.
go back to reference Chapet O, Kong FM, Quint LE, Chang AC, Ten Haken RK, Eisbruch A, Hayman JA (2005) CT-based definition of thoracic lymph node stations: an atlas from the University of Michigan. Int J Radiat Oncol Biol Phys 63:170–178. doi:10.1016/j.ijrobp.2004.12.060CrossRefPubMed Chapet O, Kong FM, Quint LE, Chang AC, Ten Haken RK, Eisbruch A, Hayman JA (2005) CT-based definition of thoracic lymph node stations: an atlas from the University of Michigan. Int J Radiat Oncol Biol Phys 63:170–178. doi:10.1016/j.ijrobp.2004.12.060CrossRefPubMed
31.
go back to reference Giraud P, De Rycke Y, Lavole A, Milleron B, Cosset JM, Rosenzweig KE (2006) Probability of mediastinal involvement in non-small-cell lung cancer: a statistical definition of the clinical target volume for 3-dimensional conformal radiotherapy? Int J Radiat Oncol Biol Phys 64:127–135. doi:10.1016/j.ijrobp.2005.06.043CrossRefPubMed Giraud P, De Rycke Y, Lavole A, Milleron B, Cosset JM, Rosenzweig KE (2006) Probability of mediastinal involvement in non-small-cell lung cancer: a statistical definition of the clinical target volume for 3-dimensional conformal radiotherapy? Int J Radiat Oncol Biol Phys 64:127–135. doi:10.1016/j.ijrobp.2005.06.043CrossRefPubMed
32.
go back to reference Rucker G, Schimek-Jasch T, Nestle U (2012) Measuring inter-observer agreement in contour delineation of medical imaging in a dummy run using Fleissʼ kappa. Methods Inf Med 51:489–494. doi:10.3414/ME12-01-0005CrossRefPubMed Rucker G, Schimek-Jasch T, Nestle U (2012) Measuring inter-observer agreement in contour delineation of medical imaging in a dummy run using Fleissʼ kappa. Methods Inf Med 51:489–494. doi:10.3414/ME12-01-0005CrossRefPubMed
33.
go back to reference Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefPubMed Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefPubMed
Metadata
Title
A teaching intervention in a contouring dummy run improved target volume delineation in locally advanced non-small cell lung cancer
Reducing the interobserver variability in multicentre clinical studies
Authors
Tanja Schimek-Jasch, M.D.
Esther G. C. Troost, M.D., Ph.D.
Gerta Rücker, Ph.D.
Vesna Prokic, Ph.D.
Melanie Avlar
Viola Duncker-Rohr, M.D.
Michael Mix, Ph.D.
Christian Doll, M.D.
Anca-Ligia Grosu, M.D., Ph.D.
Ursula Nestle, M.D., Ph.D.
Publication date
01-06-2015
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie / Issue 6/2015
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-015-0812-8

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