MRI and CT imaging for preoperative target volume delineation in breast-conserving therapy
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- 作者：Mariska D den Hartogh (5)
Marielle EP Philippens (5)
Iris E van Dam (5)
Catharina E Kleynen (5)
Robbert JHA Tersteeg (5)
Ruud M Pijnappel (6)
Alexis NTJ Kotte (5)
Helena M Verkooijen (5) (6)
Maurice AAJ van den Bosch (6)
Marco van Vulpen (5)
Bram van Asselen (5)
HJG Desirée van den Bongard (5) - 关键词：MRI ; CT ; Supine ; Interobserver variability ; Preoperative ; GTV ; Tumor bed ; Breast cancer ; Radiotherapy
- 刊名：Radiation Oncology
- 出版年：2014
- 出版时间：December 2014
- 年：2014
- 卷：9
- 期：1
- 全文大小：794 KB
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Marielle EP Philippens (5)
Iris E van Dam (5)
Catharina E Kleynen (5)
Robbert JHA Tersteeg (5)
Ruud M Pijnappel (6)
Alexis NTJ Kotte (5)
Helena M Verkooijen (5) (6)
Maurice AAJ van den Bosch (6)
Marco van Vulpen (5)
Bram van Asselen (5)
HJG Desirée van den Bongard (5)
5. Department of Radiotherapy, University Medical Center Utrecht, HP Q00.118, PO Box 85500, 3508 GA, Utrecht, The Netherlands
6. Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands - ISSN：1748-717X
文摘
Background Accurate tumor bed delineation after breast-conserving surgery is important. However, consistency among observers on standard postoperative radiotherapy planning CT is low and volumes can be large due to seroma formation. A preoperative delineation of the tumor might be more consistent. Therefore, the purpose of this study was to determine the consistency of preoperative target volume delineation on CT and MRI for breast-conserving radiotherapy. Methods Tumors were delineated on preoperative contrast-enhanced (CE) CT and newly developed 3D CE-MR images, by four breast radiation oncologists. Clinical target volumes (CTVs) were created by addition of a 1.5?cm margin around the tumor, excluding skin and chest wall. Consistency in target volume delineation was expressed by the interobserver variability. Therefore, the conformity index (CI), center of mass distance (dCOM) and volumes were calculated. Tumor characteristics on CT and MRI were scored by an experienced breast radiologist. Results Preoperative tumor delineation resulted in a high interobserver agreement with a high median CI for the CTV, for both CT (0.80) and MRI (0.84). The tumor was missed on CT in 2/14 patients (14%). Leaving these 2 patients out of the analysis, CI was higher on MRI compared to CT for the GTV (p-lt;-.001) while not for the CTV (CT (0.82) versus MRI (0.84), p--.123). The dCOM did not differ between CT and MRI. The median CTV was 48?cm3 (range 28-37?cm3) on CT and 59?cm3 (range 30-53?cm3) on MRI (p-lt;-.001). Tumor shapes and margins were rated as more irregular and spiculated on CE-MRI. Conclusions This study showed that preoperative target volume delineation resulted in small target volumes with a high consistency among observers. MRI appeared to be necessary for tumor detection and the visualization of irregularities and spiculations. Regarding the tumor delineation itself, no clinically relevant differences in interobserver variability were observed. These results will be used to study the potential for future MRI-guided and neoadjuvant radiotherapy. Trial registration International Clinical Trials Registry Platform NTR3198.