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Erschienen in: Strahlentherapie und Onkologie 6/2015

01.06.2015 | Original Article

A teaching intervention in a contouring dummy run improved target volume delineation in locally advanced non-small cell lung cancer

Reducing the interobserver variability in multicentre clinical studies

verfasst von: Tanja Schimek-Jasch, M.D., Esther G. C. Troost, M.D., Ph.D., Gerta Rücker, Ph.D., Vesna Prokic, Ph.D., Melanie Avlar, Viola Duncker-Rohr, M.D., Michael Mix, Ph.D., Christian Doll, M.D., Anca-Ligia Grosu, M.D., Ph.D., Ursula Nestle, M.D., Ph.D.

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 6/2015

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Abstract

Introduction

Interobserver variability in the definition of target volumes (TVs) is a well-known confounding factor in (multicentre) clinical studies employing radiotherapy. Therefore, detailed contouring guidelines are provided in the prospective randomised multicentre PET-Plan (NCT00697333) clinical trial protocol. This trial compares strictly FDG-PET-based TV delineation with conventional TV delineation in patients with locally advanced non-small cell lung cancer (NSCLC). Despite detailed contouring guidelines, their interpretation by different radiation oncologists can vary considerably, leading to undesirable discrepancies in TV delineation. Considering this, as part of the PET-Plan study quality assurance (QA), a contouring dummy run (DR) consisting of two phases was performed to analyse the interobserver variability before and after teaching.

Materials and methods

In the first phase of the DR (DR1), radiation oncologists from 14 study centres were asked to delineate TVs as defined by the study protocol (gross TV, GTV; and two clinical TVs, CTV-A and CTV-B) in a test patient. A teaching session was held at a study group meeting, including a discussion of the results focussing on discordances in comparison to the per-protocol solution. Subsequently, the second phase of the DR (DR2) was performed in order to evaluate the impact of teaching.

Results

Teaching after DR1 resulted in a reduction of absolute TVs in DR2, as well as in better concordance of TVs. The Overall Kappa(κ) indices increased from 0.63 to 0.71 (GTV), 0.60 to 0.65 (CTV-A) and from 0.59 to 0.63 (CTV-B), demonstrating improvements in overall interobserver agreement.

Conclusion

Contouring DRs and study group meetings as part of QA in multicentre clinical trials help to identify misinterpretations of per-protocol TV delineation. Teaching the correct interpretation of protocol contouring guidelines leads to a reduction in interobserver variability and to more consistent contouring, which should consequently improve the validity of the overall study results.
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Metadaten
Titel
A teaching intervention in a contouring dummy run improved target volume delineation in locally advanced non-small cell lung cancer
Reducing the interobserver variability in multicentre clinical studies
verfasst von
Tanja Schimek-Jasch, M.D.
Esther G. C. Troost, M.D., Ph.D.
Gerta Rücker, Ph.D.
Vesna Prokic, Ph.D.
Melanie Avlar
Viola Duncker-Rohr, M.D.
Michael Mix, Ph.D.
Christian Doll, M.D.
Anca-Ligia Grosu, M.D., Ph.D.
Ursula Nestle, M.D., Ph.D.
Publikationsdatum
01.06.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Strahlentherapie und Onkologie / Ausgabe 6/2015
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-015-0812-8

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