These do not pertain to this work and MPM declares he has no conflict of interest with regard to this study. MPM has served as a consultant to Agenus, Insys, Remedy, IBA, Varian, Oncoceutics, Astra-Zeneca, Celgene, Tocagen, and is on the DSMB of Monteris, and the Board of Oncoceutics. These do not pertain to this work and TJCW declares he has no conflict of interest with regard to this study. TJCW reports travel expenses from Abbvie, AstraZeneca, and Elekta, serves as a consultant for Abbvie, Merck, Doximity, and Elekta, is on advisory boards for American Cancer Society of New Jersey and AstraZeneca, and Honoria from Elekta and Wolthers Kluwer, and stock options from Doximity. These do not pertain to this work and CT declares she has no conflict of interest with regard to this study. These do not pertain to this work and TJK declares he has no conflict of interest with regard to this study.ĬT is on a speaker’s bureau for Merck and Varian Medical Systems, advisory board for Novocure. TJK is on a speaker’s bureau for AstraZeneca, has served as a consultant to Varian Medical Systems and was on an advisory board for Abbvie Inc. These do not pertain to this work and WRB declares he has no conflict of interest with regard to this study. WRB’s reports travel expenses from AAPM, and honoraria from Augmenix Inc. Further study is necessary to accurately define optimal target volumes beyond isometric expansion techniques for individual patients.Ĭlinical target volume Consensus Contouring Glioblastoma. Careful delineation of anatomic pathways and barriers to spread can spare radiation to uninvolved tissue without compromising target coverage. Areas for close scrutiny of target delineation were described, with accompanying recommendations.Ĭonsensus contouring guidelines were established based on expert contours. Anatomic trimming reduced the amount of total brain tissue planned for radiation targeting by a 13.6% (range 8.7-17.9%) mean proportional reduction. Simultaneous truth and performance level estimation (STAPLE) contours were then reviewed and modified by group consensus. Submitted CTV_4600 (mean kappa 0.80) and CTV_6000 (mean kappa 0.81) contours showed substantial to near perfect agreement. Experts were asked to trim off anatomic barriers while respecting pathways of spread to develop their CTVs. A meeting was held to discuss the mathematically averaged contours and form consensus contours and recommendations.Ĭontours of the cavity plus enhancement (mean kappa 0.69) and T2-FLAIR signal (mean kappa 0.74) showed moderate to substantial agreement. Contour consensus was assessed and summarized by kappa statistics. CTV expansions were based on NRG trial guidelines. Ten academic radiation oncologists specializing in brain tumor treatment contoured CTVs on four glioblastoma cases. This study proposes consensus CTV guidelines, with a focus on areas of controversy while highlighting common errors in glioblastoma target delineation. NRG protocols for glioblastoma allow for clinical target volume (CTV) reductions at natural barriers however, literature examining CTV contouring and the relevant white matter pathways is lacking. 10 Columbus Regional Health, Columbus, IN, USA.9 Miami Cancer Institute, Miami, FL, USA.8 Department of Radiation Oncology, Columbia University Medical Center, New York, NY, USA.7 Department of Radiation Oncology, Northwestern Memorial Hospital, 251 E Huron St, LC-178, Galter Pavilion, Chicago, IL, 60611, USA.6 Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.5 Department of Radiation Oncology, University of Michigan Hospital, Ann Arbor, MI, USA.Anderson Cancer Center, Houston, TX, USA. 4 Department of Radiation Oncology, University of Texas M.3 Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.2 Department of Radiation Oncology, Washington University, St. 1 Department of Radiation Oncology, Northwestern Memorial Hospital, 251 E Huron St, LC-178, Galter Pavilion, Chicago, IL, 60611, USA.
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