Variation in clinical target volume delineation in postoperative radiotherapy for biliary tract cancer

PLoS One. 2022 Sep 1;17(9):e0273395. doi: 10.1371/journal.pone.0273395. eCollection 2022.

Abstract

We aimed to evaluate the inter-clinician variability in the clinical target volume (CTV) for postoperative radiotherapy (PORT) for biliary tract cancer (BTC) including extrahepatic bile duct cancer (EBDC) and gallbladder cancer (GBC). Nine experienced radiation oncologists delineated PORT CTVs for distal EBDC (pT2N1), proximal EBDC (pT2bN1) and GBC (pT2bN1) patients. The expectation maximization algorithm for Simultaneous Truth and Performance Level Estimation (STAPLE) was used to quantify expert agreements. We generated volumes with a confidence level of 80% to compare the maximum distance to each CTV in six directions. The degree of agreement was moderate; overall kappa values were 0.573 for distal EBDC, 0.513 for proximal EBDC, and 0.511 for GBC. In the distal EBDC, a larger variation was noted in the right, post, and inferior direction. In the proximal EBDC, all borders except the right and left direction showed a larger variation. In the GBC, a larger variation was found in the anterior, posterior, and inferior direction. The posterior and inferior borders were the common area having discrepancies, associated with the insufficient coverage of the paraaortic node. A consensus guideline is needed to reduce inter-clinician variability in the CTVs and adequate coverage of regional lymph node area.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bile Duct Neoplasms* / pathology
  • Biliary Tract Neoplasms* / diagnostic imaging
  • Biliary Tract Neoplasms* / radiotherapy
  • Biliary Tract Neoplasms* / surgery
  • Consensus
  • Gallbladder Neoplasms* / pathology
  • Humans
  • Lymph Nodes / diagnostic imaging
  • Lymph Nodes / pathology
  • Observer Variation
  • Radiotherapy Planning, Computer-Assisted

Grants and funding

This study was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2021R1A2C1013797, which was received by KK. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. There was no additional external funding received for this study.