International spine radiosurgery consortium consensus guidelines for target volume definition in spinal stereotactic radiosurgery Journal Article
| Authors: | Cox, B. W.; Spratt, D. E.; Lovelock, M.; Bilsky, M. H.; Lis, E.; Ryu, S.; Sheehan, J.; Gerszten, P. C.; Chang, E.; Gibbs, I.; Soltys, S.; Sahgal, A.; Deasy, J.; Flickinger, J.; Quader, M.; Mindea, S.; Yamada, Y. |
| Article Title: | International spine radiosurgery consortium consensus guidelines for target volume definition in spinal stereotactic radiosurgery |
| Abstract: | Purpose: Spinal stereotactic radiosurgery (SRS) is increasingly used to manage spinal metastases. However, target volume definition varies considerably and no consensus target volume guidelines exist. This study proposes consensus target volume definitions using common scenarios in metastatic spine radiosurgery. Methods and Materials: Seven radiation oncologists and 3 neurological surgeons with spinal radiosurgery expertise independently contoured target and critical normal structures for 10 cases representing common scenarios in metastatic spine radiosurgery. Each set of volumes was imported into the Computational Environment for Radiotherapy Research. Quantitative analysis was performed using an expectation maximization algorithm for Simultaneous Truth and Performance Level Estimation (STAPLE) with kappa statistics calculating agreement between physicians. Optimized confidence level consensus contours were identified using histogram agreement analysis and characterized to create target volume definition guidelines. Results: Mean STAPLE agreement sensitivity and specificity was 0.76 (range, 0.67-0.84) and 0.97 (range, 0.94-0.99), respectively, for gross tumor volume (GTV) and 0.79 (range, 0.66-0.91) and 0.96 (range, 0.92-0.98), respectively, for clinical target volume (CTV). Mean kappa agreement was 0.65 (range, 0.54-0.79) for GTV and 0.64 (range, 0.54-0.82) for CTV (P<.01 for GTV and CTV in all cases). STAPLE histogram agreement analysis identified optimal consensus contours (80% confidence limit). Consensus recommendations include that the CTV should include abnormal marrow signal suspicious for microscopic invasion and an adjacent normal bony expansion to account for subclinical tumor spread in the marrow space. No epidural CTV expansion is recommended without epidural disease, and circumferential CTVs encircling the cord should be used only when the vertebral body, bilateral pedicles/lamina, and spinous process are all involved or there is extensive metastatic disease along the circumference of the epidural space. Conclusions: This report provides consensus guidelines for target volume definition for spinal metastases receiving upfront SRS in common clinical situations. © 2012 Elsevier Inc. All rights reserved. |
| Keywords: | nuclear magnetic resonance imaging; magnetic resonance imaging; sensitivity and specificity; computer assisted tomography; tumor volume; radiotherapy; practice guideline; pathology; tumors; tumor burden; radiosurgery; spinal neoplasms; stereotactic radiosurgery; spine metastasis; radiation oncologists; metastatic disease; optimization; target volumes; lumbar vertebrae; gross tumor volume; vertebral body; lumbar spine; thoracic spine; thoracic vertebrae; epidural space; vertebra body; graphic methods; cervical spine; clinical target volumes; kappa statistic; clinical situations; computational environments; confidence levels; confidence limit; expectation-maximization algorithms; normal structure; performance level; neurosurgeon; spinal stereotactic radiosurgery |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 83 |
| Issue: | 5 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2012-08-01 |
| Start Page: | e597 |
| End Page: | e605 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2012.03.009 |
| PROVIDER: | scopus |
| PUBMED: | 22608954 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 1 August 2012" - "CODEN: IOBPD" - "Source: Scopus" |
Altmetric
Citation Impact
BMJ Impact Analytics
Related MSK Work