NRG brain tumor specialists consensus guidelines for glioblastoma contouring

Timothy Joseph Kruser*, Walter R. Bosch, Shahed N. Badiyan, Joseph A. Bovi, Amol J. Ghia, Michelle M. Kim, Abhishek A. Solanki, Sean Sachdev, Christina Tsien, Tony J.C. Wang, Minesh P. Mehta, Kevin P. McMullen

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Introduction: NRG protocols for glioblastoma allow for clinical target volume (CTV) reductions at natural barriers; however, literature examining CTV contouring and the relevant white matter pathways is lacking. This study proposes consensus CTV guidelines, with a focus on areas of controversy while highlighting common errors in glioblastoma target delineation. Methods: Ten academic radiation oncologists specializing in brain tumor treatment contoured CTVs on four glioblastoma cases. CTV expansions were based on NRG trial guidelines. Contour consensus was assessed and summarized by kappa statistics. A meeting was held to discuss the mathematically averaged contours and form consensus contours and recommendations. Results: Contours of the cavity plus enhancement (mean kappa 0.69) and T2-FLAIR signal (mean kappa 0.74) showed moderate to substantial agreement. Experts were asked to trim off anatomic barriers while respecting pathways of spread to develop their CTVs. Submitted CTV_4600 (mean kappa 0.80) and CTV_6000 (mean kappa 0.81) contours showed substantial to near perfect agreement. Simultaneous truth and performance level estimation (STAPLE) contours were then reviewed and modified by group consensus. Anatomic trimming reduced the amount of total brain tissue planned for radiation targeting by a 13.6% (range 8.7–17.9%) mean proportional reduction. Areas for close scrutiny of target delineation were described, with accompanying recommendations. Conclusions: Consensus contouring guidelines were established based on expert contours. Careful delineation of anatomic pathways and barriers to spread can spare radiation to uninvolved tissue without compromising target coverage. Further study is necessary to accurately define optimal target volumes beyond isometric expansion techniques for individual patients.

Original languageEnglish (US)
JournalJournal of Neuro-Oncology
DOIs
StatePublished - Jan 1 2019

Fingerprint

Glioblastoma
Brain Neoplasms
Guidelines
Radiation
Brain
Therapeutics

Keywords

  • Clinical target volume
  • Consensus
  • Contouring
  • Glioblastoma

ASJC Scopus subject areas

  • Oncology
  • Neurology
  • Clinical Neurology
  • Cancer Research

Cite this

Kruser, Timothy Joseph ; Bosch, Walter R. ; Badiyan, Shahed N. ; Bovi, Joseph A. ; Ghia, Amol J. ; Kim, Michelle M. ; Solanki, Abhishek A. ; Sachdev, Sean ; Tsien, Christina ; Wang, Tony J.C. ; Mehta, Minesh P. ; McMullen, Kevin P. / NRG brain tumor specialists consensus guidelines for glioblastoma contouring. In: Journal of Neuro-Oncology. 2019.
@article{183aeca862c040d7a41f56aa564ce82b,
title = "NRG brain tumor specialists consensus guidelines for glioblastoma contouring",
abstract = "Introduction: NRG protocols for glioblastoma allow for clinical target volume (CTV) reductions at natural barriers; however, literature examining CTV contouring and the relevant white matter pathways is lacking. This study proposes consensus CTV guidelines, with a focus on areas of controversy while highlighting common errors in glioblastoma target delineation. Methods: Ten academic radiation oncologists specializing in brain tumor treatment contoured CTVs on four glioblastoma cases. CTV expansions were based on NRG trial guidelines. Contour consensus was assessed and summarized by kappa statistics. A meeting was held to discuss the mathematically averaged contours and form consensus contours and recommendations. Results: Contours of the cavity plus enhancement (mean kappa 0.69) and T2-FLAIR signal (mean kappa 0.74) showed moderate to substantial agreement. Experts were asked to trim off anatomic barriers while respecting pathways of spread to develop their CTVs. Submitted CTV_4600 (mean kappa 0.80) and CTV_6000 (mean kappa 0.81) contours showed substantial to near perfect agreement. Simultaneous truth and performance level estimation (STAPLE) contours were then reviewed and modified by group consensus. Anatomic trimming reduced the amount of total brain tissue planned for radiation targeting by a 13.6{\%} (range 8.7–17.9{\%}) mean proportional reduction. Areas for close scrutiny of target delineation were described, with accompanying recommendations. Conclusions: Consensus contouring guidelines were established based on expert contours. Careful delineation of anatomic pathways and barriers to spread can spare radiation to uninvolved tissue without compromising target coverage. Further study is necessary to accurately define optimal target volumes beyond isometric expansion techniques for individual patients.",
keywords = "Clinical target volume, Consensus, Contouring, Glioblastoma",
author = "Kruser, {Timothy Joseph} and Bosch, {Walter R.} and Badiyan, {Shahed N.} and Bovi, {Joseph A.} and Ghia, {Amol J.} and Kim, {Michelle M.} and Solanki, {Abhishek A.} and Sean Sachdev and Christina Tsien and Wang, {Tony J.C.} and Mehta, {Minesh P.} and McMullen, {Kevin P.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s11060-019-03152-9",
language = "English (US)",
journal = "Journal of Neuro-Oncology",
issn = "0167-594X",
publisher = "Kluwer Academic Publishers",

}

Kruser, TJ, Bosch, WR, Badiyan, SN, Bovi, JA, Ghia, AJ, Kim, MM, Solanki, AA, Sachdev, S, Tsien, C, Wang, TJC, Mehta, MP & McMullen, KP 2019, 'NRG brain tumor specialists consensus guidelines for glioblastoma contouring', Journal of Neuro-Oncology. https://doi.org/10.1007/s11060-019-03152-9

NRG brain tumor specialists consensus guidelines for glioblastoma contouring. / Kruser, Timothy Joseph; Bosch, Walter R.; Badiyan, Shahed N.; Bovi, Joseph A.; Ghia, Amol J.; Kim, Michelle M.; Solanki, Abhishek A.; Sachdev, Sean; Tsien, Christina; Wang, Tony J.C.; Mehta, Minesh P.; McMullen, Kevin P.

In: Journal of Neuro-Oncology, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - NRG brain tumor specialists consensus guidelines for glioblastoma contouring

AU - Kruser, Timothy Joseph

AU - Bosch, Walter R.

AU - Badiyan, Shahed N.

AU - Bovi, Joseph A.

AU - Ghia, Amol J.

AU - Kim, Michelle M.

AU - Solanki, Abhishek A.

AU - Sachdev, Sean

AU - Tsien, Christina

AU - Wang, Tony J.C.

AU - Mehta, Minesh P.

AU - McMullen, Kevin P.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: NRG protocols for glioblastoma allow for clinical target volume (CTV) reductions at natural barriers; however, literature examining CTV contouring and the relevant white matter pathways is lacking. This study proposes consensus CTV guidelines, with a focus on areas of controversy while highlighting common errors in glioblastoma target delineation. Methods: Ten academic radiation oncologists specializing in brain tumor treatment contoured CTVs on four glioblastoma cases. CTV expansions were based on NRG trial guidelines. Contour consensus was assessed and summarized by kappa statistics. A meeting was held to discuss the mathematically averaged contours and form consensus contours and recommendations. Results: Contours of the cavity plus enhancement (mean kappa 0.69) and T2-FLAIR signal (mean kappa 0.74) showed moderate to substantial agreement. Experts were asked to trim off anatomic barriers while respecting pathways of spread to develop their CTVs. Submitted CTV_4600 (mean kappa 0.80) and CTV_6000 (mean kappa 0.81) contours showed substantial to near perfect agreement. Simultaneous truth and performance level estimation (STAPLE) contours were then reviewed and modified by group consensus. Anatomic trimming reduced the amount of total brain tissue planned for radiation targeting by a 13.6% (range 8.7–17.9%) mean proportional reduction. Areas for close scrutiny of target delineation were described, with accompanying recommendations. Conclusions: Consensus contouring guidelines were established based on expert contours. Careful delineation of anatomic pathways and barriers to spread can spare radiation to uninvolved tissue without compromising target coverage. Further study is necessary to accurately define optimal target volumes beyond isometric expansion techniques for individual patients.

AB - Introduction: NRG protocols for glioblastoma allow for clinical target volume (CTV) reductions at natural barriers; however, literature examining CTV contouring and the relevant white matter pathways is lacking. This study proposes consensus CTV guidelines, with a focus on areas of controversy while highlighting common errors in glioblastoma target delineation. Methods: Ten academic radiation oncologists specializing in brain tumor treatment contoured CTVs on four glioblastoma cases. CTV expansions were based on NRG trial guidelines. Contour consensus was assessed and summarized by kappa statistics. A meeting was held to discuss the mathematically averaged contours and form consensus contours and recommendations. Results: Contours of the cavity plus enhancement (mean kappa 0.69) and T2-FLAIR signal (mean kappa 0.74) showed moderate to substantial agreement. Experts were asked to trim off anatomic barriers while respecting pathways of spread to develop their CTVs. Submitted CTV_4600 (mean kappa 0.80) and CTV_6000 (mean kappa 0.81) contours showed substantial to near perfect agreement. Simultaneous truth and performance level estimation (STAPLE) contours were then reviewed and modified by group consensus. Anatomic trimming reduced the amount of total brain tissue planned for radiation targeting by a 13.6% (range 8.7–17.9%) mean proportional reduction. Areas for close scrutiny of target delineation were described, with accompanying recommendations. Conclusions: Consensus contouring guidelines were established based on expert contours. Careful delineation of anatomic pathways and barriers to spread can spare radiation to uninvolved tissue without compromising target coverage. Further study is necessary to accurately define optimal target volumes beyond isometric expansion techniques for individual patients.

KW - Clinical target volume

KW - Consensus

KW - Contouring

KW - Glioblastoma

UR - http://www.scopus.com/inward/record.url?scp=85063194539&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85063194539&partnerID=8YFLogxK

U2 - 10.1007/s11060-019-03152-9

DO - 10.1007/s11060-019-03152-9

M3 - Article

JO - Journal of Neuro-Oncology

JF - Journal of Neuro-Oncology

SN - 0167-594X

ER -