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BMC Cancer
Published in: BMC Cancer 1/2015

Open Access 01-12-2015 | Research article

Multimodality imaging with CT, MR and FDG-PET for radiotherapy target volume delineation in oropharyngeal squamous cell carcinoma

Authors: David Bird, Andrew F. Scarsbrook, Jonathan Sykes, Satiavani Ramasamy, Manil Subesinghe, Brendan Carey, Daniel J. Wilson, Neil Roberts, Gary McDermott, Ebru Karakaya, Evrim Bayman, Mehmet Sen, Richard Speight, Robin J.D. Prestwich

Published in: BMC Cancer | Issue 1/2015

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Abstract

Background

This study aimed to quantify the variation in oropharyngeal squamous cell carcinoma gross tumour volume (GTV) delineation between CT, MR and FDG PET-CT imaging.

Methods

A prospective, single centre, pilot study was undertaken where 11 patients with locally advanced oropharyngeal cancers (2 tonsil, 9 base of tongue primaries) underwent pre-treatment, contrast enhanced, FDG PET-CT and MR imaging, all performed in a radiotherapy treatment mask. CT, MR and CT-MR GTVs were contoured by 5 clinicians (2 radiologists and 3 radiation oncologists). A semi-automated segmentation algorithm was used to contour PET GTVs. Volume and positional analyses were undertaken, accounting for inter-observer variation, using linear mixed effects models and contour comparison metrics respectively.

Results

Significant differences in mean GTV volume were found between CT (11.9 cm3) and CT-MR (14.1 cm3), p < 0.006, CT-MR and PET (9.5 cm3), p < 0.0009, and MR (12.7 cm3) and PET, p < 0.016. Substantial differences in GTV position were found between all modalities with the exception of CT-MR and MR GTVs. A mean of 64 %, 74 % and 77 % of the PET GTVs were included within the CT, MR and CT-MR GTVs respectively. A mean of 57 % of the MR GTVs were included within the CT GTV; conversely a mean of 63 % of the CT GTVs were included within the MR GTV. CT inter-observer variability was found to be significantly higher in terms of position and/or volume than both MR and CT-MR (p < 0.05). Significant differences in GTV volume were found between GTV volumes delineated by radiologists (9.7 cm3) and oncologists (14.6 cm3) for all modalities (p = 0.001).

Conclusions

The use of different imaging modalities produced significantly different GTVs, with no single imaging technique encompassing all potential GTV regions. The use of MR reduced inter-observer variability. These data suggest delineation based on multimodality imaging has the potential to improve accuracy of GTV definition.

Trial registration

ISRCTN Registry: ISRCTN34165059. Registered 2nd February 2015.
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Metadata
Title
Multimodality imaging with CT, MR and FDG-PET for radiotherapy target volume delineation in oropharyngeal squamous cell carcinoma
Authors
David Bird
Andrew F. Scarsbrook
Jonathan Sykes
Satiavani Ramasamy
Manil Subesinghe
Brendan Carey
Daniel J. Wilson
Neil Roberts
Gary McDermott
Ebru Karakaya
Evrim Bayman
Mehmet Sen
Richard Speight
Robin J.D. Prestwich
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2015
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-015-1867-8

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