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Radiation Oncology
Published in: Radiation Oncology 1/2018

Open Access 01-12-2018 | Research

The impact of contour variation on tumour control probability in anal cancer

Authors: Michael P. Jones, Jarad Martin, Kerwyn Foo, Patrick Estoesta, Lois Holloway, Michael Jameson

Published in: Radiation Oncology | Issue 1/2018

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Abstract

Background

While intensity modulated radiotherapy (IMRT) has been widely adopted for the treatment of anal cancer (AC), the added contour complexity poses potential risks. This study investigates the impact of contour variation on tumour control probability (TCP) when using IMRT for AC.

Methods

Nine Australian centres contoured a single computed tomography dataset of a patient with AC. The same optimised template-based IMRT planning protocol was applied to each contour set to generate nine representative treatment plans and their corresponding dose volume histograms. A geometric analysis was performed on all contours. The TCP was calculated for each plan using the linear quadratic and logitEUD model.

Results

The median concordance index (CI) for the bladder, head and neck of femur, bone marrow, small bowel and external genitalia was 0.94, 0.88, 0.84, 0.65 and 0.65, respectively. The median CI for the involved nodal, primary tumour and elective clinical target volumes were 0.85, 0.77 and 0.71, respectively. Across the nine plans, the TCP was not significantly different. Variation in TCP between plans increased as tumour cell load increased or radiation dose decreased.

Conclusions

When using IMRT for AC, contour variations generated from a common protocol within the limits of minor deviations do not appear to have a significant impact on TCP. Contouring variations may be more critical with increasing tumour cell load or reducing radiotherapy dose.
Appendix
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Literature
1.
Steele SR, Varma MG, Melton GB, Ross HM, Rafferty JF, Buie WD. Practice parameters for anal squamous neoplasms. Dis Colon rectum. 2012;55:735–49.CrossRefPubMed
2.
3.
Jemal A, Simard EP, Dorell C, Noone A-M, Markowitz LE, Kohler B, Eheman C, Saraiya M, Bandi P, Saslow D, Cronin KA, Watson M, Schiffman M, Henley SJ, Schymura MJ, Anderson RN, Yankey D, Edwards BK. Annual report to the nation on the status of Cancer, 1975-2009, featuring the burden and trends in human papillomavirus(HPV)-associated cancers and HPV vaccination coverage levels. JNCI Journal of the National Cancer Institute. 2013;105:175–201.CrossRefPubMedPubMedCentral
4.
5.
Glynne-Jones R, Nilsson PJ, Aschele C, Goh V, Peiffert D, Cervantes A, Arnold D, ESMO, ESSO, ESTRO: Anal cancer: ESMO-ESSO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up. Radiother oncol. 2014;11:330–39.
6.
Martenson JA, Lipsitz SR, Lefkopoulou M, Engstrom PF, Dayal YY, Cobau CD, Oken MM, Haller DG. Results of combined modality therapy for patients with anal cancer (E7283). An eastern cooperative oncology group study. Cancer. 1995;76:1731–6.CrossRefPubMed
7.
Peiffert D, Seitz JF, Rougier P, Francois E, Cvitkovic F, Mirabel X, Nasca S, Ducreux M, Hannoun-Levi JM, Lusinchi A, Debrigode E, Conroy T, Pignon JP, Gerard JP. Preliminary results of a phase II study of high-dose radiation therapy and neoadjuvant plus concomitant 5-fluorouracil with CDDP chemotherapy for patients with anal canal cancer: a French cooperative study. Ann Oncol. 1997;8:575–81.CrossRefPubMed
8.
Gerard JP, Ayzac L, Hun D, Romestaing P, Coquard R, Ardiet JM, Mornex F. Treatment of anal canal carcinoma with high dose radiation therapy and concomitant fluorouracil-cisplatinum. Long-term results in 95 patients. Radiother Oncol. 1998;46:249–56.CrossRefPubMed
9.
Bentzen AG, Guren MG, Vonen B, Wanderås EH, Frykholm G, Wilsgaard T, Dahl O, Balteskard L. Radiotherapy and oncology. Radiother Oncol. 2013;108:55–60.CrossRefPubMed
10.
Kachnic LA, Winter K, Myerson RJ, Goodyear MD, Willins J, Esthappan J, Haddock MG, Rotman M, Parikh PJ, Safran H, Willett CG. RTOG 0529: a phase 2 evaluation of dose-painted intensity modulated radiation therapy in combination with 5-fluorouracil and mitomycin-C for the reduction of acute morbidity in carcinoma of the anal canal. Int J Radiat Oncol Biol Phys. 2013;86:27–33.CrossRefPubMed
11.
Peters LJ, O'Sullivan B, Giralt J, Fitzgerald TJ, Trotti A, Bernier J, Bourhis J, Yuen K, Fisher R, Rischin D. Critical impact of radiotherapy protocol compliance and quality in the treatment of advanced head and neck Cancer: results from TROG 02.02. J Clin Oncol. 2010;28:2996–3001.CrossRefPubMed
12.
Chen AM, Chin R, Beron P, Yoshizaki T, Mikaeilian AG, Cao M. Inadequate target volume delineation and local-regional recurrence after intensity-modulated radiotherapy for human papillomavirus-positive oropharynx cancer. Radiother Oncol. 2017;123:412–8.CrossRefPubMed
13.
Amini A, Jones BL, Ghosh D, Schefter TE, Goodman KA. Impact of facility volume on outcomes in patients with squamous cell carcinoma of the anal canal: analysis of the National Cancer Data Base. Cancer. 2017;123:228–36.CrossRefPubMed
14.
Trans Tasman Radiation Oncology Group: The assessment of new radiation oncology technologies and treatments (ANROTAT): study protocol B (IMRT Anal Canal) final report. 2012.
15.
Ng M, Leong T, Chander S, Chu J, Kneebone A, Carroll S, Wiltshire K, Ngan S, Kachnic L. Australasian gastrointestinal trials group (AGITG) contouring atlas and planning guidelines for intensity-modulated radiotherapy in anal cancer. Radiat Oncol Biol. 2012;83:1455–62.CrossRef
16.
Warfield SK, Zou KH, Wells WM. Simultaneous truth and performance level estimation (STAPLE): an algorithm for the validation of image segmentation. IEEE Trans Med Imaging. 2004;23:903–21.CrossRefPubMedPubMedCentral
17.
Deasy JO, Blanco AI, Clark VH. CERR: a computational environment for radiotherapy research. Med Phys. 2003;30:979–85.CrossRefPubMed
18.
Holloway LC, Miller J-A, Kumar S, Whelan BM, Vinod SK. Comp plan: a computer program to generate dose and radiobiological metrics from dose-volume histogram files. Med Dosim. 2012;37:305–9.CrossRefPubMed
19.
Muirhead R, Partridge M, Hawkins MA. A tumor control probability model for anal squamous cell carcinoma. Radiother Oncol. 2015;116:192–6.CrossRefPubMed
20.
Gay HA, Barthold HJ, O'Meara E, Bosch WR, Naqa El I, Al-Lozi R, Rosenthal SA, Lawton C, Lee WR, Sandler H, Zietman A, Myerson R, Dawson LA, Willett C, Kachnic LA, Jhingran A, Portelance L, Ryu J, Small W, Gaffney D, Viswanathan AN, Michalski JM. Pelvic normal tissue contouring guidelines for radiation therapy: a radiation therapy oncology group consensus panel atlas. Int J Radiat Oncol Biol Phys. 2012;83:e353–62.CrossRefPubMedPubMedCentral
21.
Kavanagh BD, Pan CC, Dawson LA, Das SK, Li XA, Haken Ten RK, Miften M. Radiation dose-volume effects in the stomach and small bowel. Int J Radiat Oncol Biol Phys. 2010;76:S101–7.CrossRefPubMed
22.
Dominello MM, Nalichowski A, Paximadis P, Kaufman I, McSpadden E, Joiner M, Miller S, Konski A. Limitations of the bowel bag contouring technique in the definitive treatment of cervical cancer. Practical Radiation Oncology. 2014;4:e15–20.CrossRefPubMed
23.
Kachnic LA, Tsai HK, Coen JJ, Blaszkowsky LS, Hartshorn K, Kwak EL, Willins JD, Ryan DP, Hong TS. Dose-painted intensity-modulated radiation therapy for anal Cancer: a multi-institutional report of acute toxicity and response to therapy. Int J Radiat Oncol Biol Phys. 2012;82:153–8.CrossRefPubMed
24.
Brooks C, Hansen VN, Riddell A, Harris VA, Tait DM. Proposed genitalia contouring guidelines in anal cancer intensity-modulated radiotherapy. Br J Radiol. 2015;88:20150032–7.CrossRefPubMedPubMedCentral
25.
Brown E, Cray A, Haworth A, Chander S, Lin R, Subramanian B, Ng M. Dose planning objectives in anal canal cancer IMRT: the TROG ANROTAT experience. J Med Radiat Sci. 2015;62:99–107.CrossRefPubMedPubMedCentral
26.
Hornby CJ, Ackerly T, See A, Geso M. Exploring the effect of marked normal structure volume on normal tissue complication probability. Med Dosim. 2003;28:223–7.CrossRefPubMed
27.
Koeck J, Lohr F, Buergy D, Büsing K, Trunk MJ, Wenz F, Mai S. Genital invasion or perigenital spread may pose a risk of marginal misses for intensity modulated radiotherapy (IMRT) in anal cancer. Radiat Oncol. 2016:1–8.
28.
Koeck J, Lohr F, Buergy D, Büsing K, Trunk MJ, Wenz F, Mai S. Genital invasion or perigenital spread may pose a risk of marginal misses for Intensity Modulated Radiotherapy (IMRT) in anal cancer. Radiat Oncol. 2016;11:53.
29.
Dell’Acqua V, Kobiela J, Kraja F, Leonardi MC, Surgo A, Zerella MA, Arculeo S, Fodor C, Ricotti R, Zampino MG, Ravenda S, Spinoglio G, Biffi R, Bazani A, Luraschi R, Vigorito S, Spychalski P, Orecchia R, Glynne-Jones R, Jereczek-Fossa BA. Genital marginal failures after intensity-modulated radiation therapy (IMRT) in squamous cell anal cancer: no higher risk with IMRT when compared to 3DCRT. Medical Oncology. 2018;35:59.
30.
Vinod SK, Min M, Jameson MG, Holloway LC. A review of interventions to reduce inter-observer variability in volume delineation in radiation oncology. Journal of Medical Imaging and Radiation Oncology. 2016;60:393–406.CrossRefPubMed
31.
Glynne-Jones R, Tan D, Hughes R, Hoskin P. Squamous-cell carcinoma of the anus: progress in radiotherapy treatment. Nat Rev Clin Oncol. 2016;13:447–59.CrossRefPubMed
32.
Fuller CD, Nijkamp J, Duppen JC, Rasch CRN, Thomas CR, Wang SJ, Okunieff P, Jones WE, Baseman D, Patel S, Demandante CGN, Harris AM, Smith BD, Katz AW, McGann C, Harper JL, Chang DT, Smalley S, Marshall DT, Goodman KA, Papanikolaou N, Kachnic LA, Radiation Oncology Committee of the Southwest Oncology Group. Prospective randomized double-blind pilot study of site-specific consensus atlas implementation for rectal cancer target volume delineation in the cooperative group setting. Int J Radiat Oncol Biol Phys. 2011;79:481–9.CrossRefPubMed
33.
Jones M, Hruby G, Solomon M, Rutherford N, Martin J. The role of FDG-PET in the initial staging and response assessment of anal Cancer: a systematic review and meta-analysis. Ann Surg Oncol. 2015;22:3574–81.CrossRefPubMed
34.
35.
Batumalai V, Jameson MG, Forstner DF, Vial P, Holloway LC. How important is dosimetrist experience for intensity modulated radiation therapy? A comparative analysis of a head and neck case. Practical Radiation Oncology. 2013;3:e99–e106.CrossRefPubMed
36.
Gilbert DC, Williams A, Allan K, Stokoe J, Jackson T, Linsdall S, Bailey CM, Summers J. p16INK4A, p53, EGFR expression and KRAS mutation status in squamous cell cancers of the anus: correlation with outcomes following chemo-radiotherapy. Radiother Oncol. 2013;109:146–51.CrossRefPubMed
37.
Jones M, Hruby G, Stanwell P, Gallagher S, Wong K, Arm J, Martin J. Multiparametric MRI as an outcome predictor for anal canal cancer managed with chemoradiotherapy. BMC Cancer. 2015;15:281.CrossRefPubMedPubMedCentral
Metadata
Title
The impact of contour variation on tumour control probability in anal cancer
Authors
Michael P. Jones
Jarad Martin
Kerwyn Foo
Patrick Estoesta
Lois Holloway
Michael Jameson
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2018
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-018-1033-y

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