Comparison of investigator-delineated gross tumour volumes and quality assurance in pancreatic cancer: Analysis of the on-trial cases for the SCALOP trial

Emmanouil Fokas, Emiliano Spezi, Neel Patel, Chris Hurt, Lisette Nixon, Kwun-Ye Chu, John Staffurth, Ross Abrams, Somnath Mukherjee, Emmanouil Fokas, Emiliano Spezi, Neel Patel, Chris Hurt, Lisette Nixon, Kwun-Ye Chu, John Staffurth, Ross Abrams, Somnath Mukherjee

Abstract

Background and purpose: We performed a retrospective central review of tumour outlines in patients undergoing radiotherapy in the SCALOP trial.

Materials and methods: The planning CT scans were reviewed retrospectively by a central review team, and the accuracy of investigators' GTV (iGTV) and PTV (iPTV) was compared to the trials team-defined gold standard (gsGTV and gsPTV) using the Jaccard Conformity Index (JCI) and Geographical Miss Index (GMI). The prognostic value of JCI and GMI was also assessed. The RT plans were also reviewed against protocol-defined constraints.

Results: 60 patients with diagnostic-quality planning scans were included. The median whole volume JCI for GTV was 0.64 (IQR: 0.43-0.82), and the median GMI was 0.11 (IQR: 0.05-0.22). For PTVs, the median JCI and GMI were 0.80 (IQR: 0.71-0.88) and 0.04 (IQR: 0.02-0.12) respectively. Tumour was completely missed in 1 patient, and⩾50% of the tumour was missed in 3. Patients with JCI for GTV⩾0.7 had 7.12 (95% CIs: 1.83-27.67, p=0.005) higher odds of progressing by 9months in multivariate analysis. Major deviations in RT planning were noted in 4.5% of cases.

Conclusions: Radiotherapy workshops and real-time central review of contours are required in RT trials of pancreatic cancer.

Keywords: Conformity index; Pancreas; Prospective trial; Quality assurance; Radiotherapy.

Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Figures

Fig. 1
Fig. 1
Scatter plot showing the correlation of the Geographical Miss Index (GMI) and the Jaccard Conformity Index (JCI) with (A) the investigator gross tumour volumes (iGTVs) and (B) the investigator planning target volumes (iPTVs).
Fig. 2
Fig. 2
Distributions of the JCI and GMI indices by progression status at 9 months.
Fig. 3
Fig. 3
Illustration of the relationship between on-trial planning assessment form (PAF) value and the Visualization and Organization of Data for Cancer Analysis programme (VODCA) values in n = 66 cases, as indicated (A–F). Minor deviations are shown with black squares. Incorrect identification of the ipsilateral kidney (C) occurred in two cases (shown with circle).

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Source: PubMed

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