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Open Access 01-12-2014 | Research

Target volume delineation in breast conserving radiotherapy: are co-registered CT and MR images of added value?

Authors: Mirjam Mast, Emile Coerkamp, Mark Heijenbrok, Astrid Scholten, Wim Jansen, Erik Kouwenhoven, Jasper Nijkamp, Stephanie de Waard, Anna Petoukhova, Henk Struikmans

Published in: Radiation Oncology | Issue 1/2014

Abstract

Introduction

In breast conserving radiotherapy differences of target volume delineations between observers do occur. We evaluated whether delineations based on co-registered computed tomography (CT) and magnetic resonance (MR) imaging may result in an improved consistency between observers. We used the delineation conformity index (CI) to compare clinical target volumes of glandular breast tissue (CTV breast) and lumpectomy cavity (LC) on both imaging modalities.

Methods and materials

Four observers delineated CTV breast and LC on co-registered CTMR images in ten breast cancer patients. CIs were determined for CT and CTMR. Furthermore, the Cavity Visualization Score (CVS) of LC was taken into account.

Results

The mean CI for CTV breast (CI_CT;CTV: 0.82 and CI_CT-CTMR;CTV: 0.80) and LC (CI_CT;LC: 0.52 and CI_CT-CTMR;LC: 0.48) did not differ significantly (p = 0.07 and p = 0.33, respectively). Taking CVS into account for the LC, with a CVS ≥ 4 the mean CI was 0.62 for both CI_CT;LC and CI_CT-CTMR;LC.

Conclusion

The mean volume of the delineated glandular breast tissue based on CT was significantly larger compared to the volume based on CTMR. For patients with a CVS ≥ 4, the mean CIs of the LC were higher compared to CVS < 4 for volumes delineated on both CT as well as CTMR images. In our study cohort no significant differences between the CIs of the CTV breast and the LC delineated on CTMR co-registered images were found compared to the CIs on CT images only. Adding MR images does not seem to improve consistency of the delineation of the CTV breast and the LC, even though the volumes were copied from CT images. Since we included only ten patients, caution should be taken with regard to the results of our study.

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Landis DM, Luo W, Song J, Bellon JR, Punglia RS, Wong JS, Killoran JH, Gelman R, Harris JR: Variability among breast radiation oncologists in delineation of the postsurgical lumpectomy cavity. Int J Radiation Oncology Biol Phys 2007, 67: 1299-1308. 10.1016/j.ijrobp.2006.11.026CrossRef

Struikmans H, Wárlám-Rodenhuis C, Stam T, Stapper G, Tersteeg RJHA, Bol GH, Raaijmakers CPJ: Interobserver variability of target volume delineation of glandular breast tissue and of boost volume in tangential breast irradiation. Radiother Oncol 2005, 76: 293-299. 10.1016/j.radonc.2005.03.029CrossRefPubMed

van Mourik AM, Elkhuizen PH, Minkema D, van Vliet-Vroegindeweij C, Dutch Young Boost Study Group: Collaborators (15). Multi institutional study on target volume delineation variation in breast radiotherapy in the presence of guidelines. Radiother Oncol 2010, 94: 286-291. 10.1016/j.radonc.2010.01.009CrossRefPubMed

Boersma LJ, Janssen T, Elkhuizen PHM, Poortmans P, van der Sangen M, Scholten AN, Hanbeukers B, Duppen JC, Hurkmans C, van Vliet C: Reducing interobserver variation of boost-CTV delineation in breast conserving radiation therapy using a pre-operative CT and delineation guidelines. Radiother Oncol 2012, 103: 178-182. 10.1016/j.radonc.2011.12.021CrossRefPubMed

Whipp EC, Halliwell M: Magnetic resonance imaging appearances in the postoperative breast: the clinical target volume-tumor and its relationship to the chest wall. Int J Radiation Oncology Biol Phys 2008, 72: 49-57. 10.1016/j.ijrobp.2007.12.021CrossRef

Jolicoeur M, Racine M, Trop I, Hathout L, Nguyen D, Derashodian T, David S: Localization of the surgical bed using supine magnetic resonance and computed tomography scan fusion for planification of breast interstitial brachytherapy. Radiother Oncol 2011, 100: 480-484. 10.1016/j.radonc.2011.08.024CrossRefPubMed

Giezen M, Kouwenhoven E, Scholten AN, Coerkamp EG, Heijenbrok M, Jansen WPA, Mast ME, Petoukhova AL, Struikmans H: Magnetic resonance imaging – versus computed tomography- based target volume delineation of the glandular breast tissue (clinical target volume breast) in breast–conserving therapy: an exploratory study. Int J Radiation Oncology Biol Phys 2011, 81: 804-811. 10.1016/j.ijrobp.2010.07.004CrossRef

Petoukhova A, Mast ME, Kouwenhoven E, Jansen WPA, Scholten AN, Struikmans H: Optimal registration method of mri and ct for delineation in radiotherapy planning of breast cancer patients treated with breast conserving therapy. Int J Radiation Oncology Biol Phys 2013, 87: S209.CrossRef

Giezen M, Kouwenhoven E, Scholten AN, Coerkamp EG, Heijenbrok M, Jansen WPA, Mast ME, Petoukhova AL, Struikmans H: MRI- versus CT-based volume delineation of lumpectomy cavity in supine position in breast-conserving therapy: an exploratory study. Int J Radiation Oncology Biol Phys 2012, 82: 1332-1340. 10.1016/j.ijrobp.2011.05.008CrossRef

10.

Kouwenhoven E, Giezen M, Struikmans H: Measuring the similarity of target volume delineations independent of the number of observers. Phys Med Biol 2009, 54: 2863-2873. 10.1088/0031-9155/54/9/018CrossRefPubMed

11.

Smitt MC, Birdwell RL, Goffinet DR: Breast electron boost planning: Comparison of CT and US. Radiology 2001, 219: 203-206. 10.1148/radiology.219.1.r01ap34203CrossRefPubMed

12.

Deurloo KEI, Steenbakkers RJHM, Zijp LJ, de Bois JA, Nowak PJCM, Rasch CRN, van Herk M: Quantification of shape variation of prostate and seminal vesicles during external beam radiotherapy. Int J Radiation Oncology Biol Phys 2005, 61: 228-238. 10.1016/j.ijrobp.2004.09.023CrossRef

13.

Li XA, Tai A, Arthur DW, Buchholz TA, MacDonald S, Marks LB, Moran JM, Pierce LJ, Rabinovitch R, Taghian A, Vicini F, Woodward W, White JR: Variability of target and normal structure delineation for breast cancer radiotherapy: an RTOG multi-institutional and multiobserver study. Int J Radiation Oncology Biol Phys 2009, 73: 944-951. 10.1016/j.ijrobp.2008.10.034CrossRef

14.

Wong EK, Truong PT, Kader HA, Nichol AM, Salter L, Petersen R, Wai ES, Weir L, Olivotto IA: Consistency in seroma contouring for partial breast radiotherapy: impact of guidelines. Int J Radiation Oncology Biol Phys 2006, 66: 372-376. 10.1016/j.ijrobp.2006.05.066CrossRef

15.

Dzhugashvili M, Pichenot C, Dunant A, Balleyguier C, Delaloge S, Mathieu M, Garbay J, Marsiglia H, Bourgier C: Surgical clips assist in the visualization of the lumpectomy cavity in three-dimensional conformal accelerated partial-breast irradiation. Int J Radiation Oncology Biol Phys 2010, 76: 1320-1324. 10.1016/j.ijrobp.2009.04.089CrossRef

16.

Topolnjak R, de Ruiter P, Remeijer P, Vliet-Vroegindeweij C, Rasch C, Sonke JJ: Image-guided radiotherapy for breast cancer patients: surgical clips as surrogate for breast excision cavity. Int J Radiation Oncology Biol Phys 2011, 81: 187-195.CrossRef

17.

Park CK, Pritz J, Zhang GG: Validating fiducial markers for image-guided radiation therapy for accelerated partial breast irradiation in early-stage breast cancer. Int J Radiation Oncology Biol Phys 2012, 82: e425-e431. 10.1016/j.ijrobp.2011.07.027CrossRef

18.

Ahunbay EE, Robbins J, Christian R, Godley A, White J, Li A: Interfractional target variations for partial breast irradiation. Int J Radiation Oncology Biol Phys 2012, 82: 1594-1604. 10.1016/j.ijrobp.2011.01.041CrossRef

19.

Yang Z, Chen J, Hu W, Pan Z, Cai G, Yu X, Mei X, Zhagn Q, Liu T, Guo X: Planning the breast boost: How accurately do surgical clips represent the CT seroma? Radiother Oncol 2010, 97: 530-534. 10.1016/j.radonc.2010.09.007CrossRefPubMed

Title: Target volume delineation in breast conserving radiotherapy: are co-registered CT and MR images of added value?
Authors: Mirjam Mast
Emile Coerkamp
Mark Heijenbrok
Astrid Scholten
Wim Jansen
Erik Kouwenhoven
Jasper Nijkamp
Stephanie de Waard
Anna Petoukhova
Henk Struikmans
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2014
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/1748-717X-9-65

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Target volume delineation in breast conserving radiotherapy: are co-registered CT and MR images of added value?

Abstract

Introduction

Methods and materials

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods and materials

Results

Conclusion

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