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La radiologia medica
Published in: La radiologia medica 3/2023

01-03-2023 | Radiotherapy

Nasopharyngeal cancer: the impact of guidelines and teaching on radiation target volume delineation

Authors: Francesco Dionisi, Alessia Di Rito, Angelo Errico, Giuseppe Iaccarino, Alessia Farneti, Pasqualina D’Urso, Alessia Nardangeli, Santa Bambace, Ida D’Onofrio, Elisa D’Angelo, Francesca De Felice, Giuseppe Fanetti, Liliana Belgioia, Daniela Alterio, Ester Orlandi, Anna Merlotti, Daniela Musio, Giuseppe Sanguineti

Published in: La radiologia medica | Issue 3/2023

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Abstract

Target volume delineation in the radiation treatment of nasopharyngeal cancer is challenging due to several reasons such as the complex anatomy of the site, the need for the elective coverage of definite anatomical regions, the curative intent of treatment and the rarity of the disease, especially in non-endemic areas. We aimed to analyze the impact of educational interactive teaching courses on target volume delineation accuracy between Italian radiation oncology centers. Only one contour dataset per center was admitted. The educational course consisted in three parts: (1) The completely anonymized image dataset of a T4N1 nasopharyngeal cancer patient was shared between centers before the course with the request of target volume and organs at risk delineation; (2) the course was held online with dedicated multidisciplinary sessions on nasopharyngeal anatomy, nasopharyngeal cancer pattern of diffusion and on the description and explanation of international contouring guidelines. At the end of the course, the participating centers were asked to resubmit the contours with appropriate corrections; (3) the pre- and post-course contours were analyzed and quantitatively and qualitatively compared with the benchmark contours delineated by the panel of experts. The analysis of the 19 pre- and post-contours submitted by the participating centers revealed a significant improvement in the Dice similarity index in all the clinical target volumes (CTV1, CTV2 and CTV3) passing from 0.67, 0.51 and 0.48 to 0.69, 0.65 and 0.52, respectively. The organs at risk delineation was also improved. The qualitative analysis consisted in the evaluation of the inclusion of the proper anatomical regions in the target volumes; it was conducted following internationally validated guidelines of contouring for nasopharyngeal radiation treatment. All the sites were properly included in target volume delineation by  >50% of the centers after correction. A significant improvement was registered for the skull base, the sphenoid sinus and the nodal levels. These results demonstrated the important role that educational courses with interactive sessions could have in such a challenging task as target volume delineation in modern radiation oncology.
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Metadata
Title
Nasopharyngeal cancer: the impact of guidelines and teaching on radiation target volume delineation
Authors
Francesco Dionisi
Alessia Di Rito
Angelo Errico
Giuseppe Iaccarino
Alessia Farneti
Pasqualina D’Urso
Alessia Nardangeli
Santa Bambace
Ida D’Onofrio
Elisa D’Angelo
Francesca De Felice
Giuseppe Fanetti
Liliana Belgioia
Daniela Alterio
Ester Orlandi
Anna Merlotti
Daniela Musio
Giuseppe Sanguineti
Publication date
01-03-2023
Publisher
Springer Milan
Published in
La radiologia medica / Issue 3/2023
Print ISSN: 0033-8362
Electronic ISSN: 1826-6983
DOI
https://doi.org/10.1007/s11547-023-01612-x

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