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Nasopharyngeal cancer: the impact of guidelines and teaching on radiation target volume delineation

  • Radiotherapy
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Abstract

Target volume delineation in the radiation treatment of nasopharyngeal cancer is challenging due to several reasons such as the complex anatomy of the site, the need for the elective coverage of definite anatomical regions, the curative intent of treatment and the rarity of the disease, especially in non-endemic areas. We aimed to analyze the impact of educational interactive teaching courses on target volume delineation accuracy between Italian radiation oncology centers. Only one contour dataset per center was admitted. The educational course consisted in three parts: (1) The completely anonymized image dataset of a T4N1 nasopharyngeal cancer patient was shared between centers before the course with the request of target volume and organs at risk delineation; (2) the course was held online with dedicated multidisciplinary sessions on nasopharyngeal anatomy, nasopharyngeal cancer pattern of diffusion and on the description and explanation of international contouring guidelines. At the end of the course, the participating centers were asked to resubmit the contours with appropriate corrections; (3) the pre- and post-course contours were analyzed and quantitatively and qualitatively compared with the benchmark contours delineated by the panel of experts. The analysis of the 19 pre- and post-contours submitted by the participating centers revealed a significant improvement in the Dice similarity index in all the clinical target volumes (CTV1, CTV2 and CTV3) passing from 0.67, 0.51 and 0.48 to 0.69, 0.65 and 0.52, respectively. The organs at risk delineation was also improved. The qualitative analysis consisted in the evaluation of the inclusion of the proper anatomical regions in the target volumes; it was conducted following internationally validated guidelines of contouring for nasopharyngeal radiation treatment. All the sites were properly included in target volume delineation by  >50% of the centers after correction. A significant improvement was registered for the skull base, the sphenoid sinus and the nodal levels. These results demonstrated the important role that educational courses with interactive sessions could have in such a challenging task as target volume delineation in modern radiation oncology.

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Acknowledgements

The Authors thank the Scientific Committee and Board of the AIRO for the critical revision and final approval of the manuscript

Funding

This research received no funding.

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Authors and Affiliations

  1. Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy

    Francesco Dionisi, Alessia Farneti, Pasqualina D’Urso, Alessia Nardangeli & Giuseppe Sanguineti

  2. Radiation Oncology Unit, Hospital “Mons. A.R. Dimiccoli”, Barletta, Italy

    Alessia Di Rito, Angelo Errico & Santa Bambace

  3. Laboratory of Medical Physics and Expert Systems, IRCSS Regina Elena National Cancer Institute, Rome, Italy

    Giuseppe Iaccarino

  4. Unit of Radiation Oncology, Ospedale del Mare, Naples, Italy

    Ida D’Onofrio

  5. Department of Radiation Oncology, University Hospital of Modena, Modena, Italy

    Elisa D’Angelo

  6. Department of Radiotherapy, Policlinico Umberto I, “Sapienza” University of Rome, Rome, Italy

    Francesca De Felice

  7. Division of Radiotherapy, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy

    Giuseppe Fanetti

  8. Department of Radiation Oncology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy

    Liliana Belgioia

  9. Department of Health Science (DISSAL), University of Genoa, Genoa, Italy

    Liliana Belgioia

  10. Division of Radiation Oncology, European Institute of Oncology (IEO), IRCCS, Milan, Italy

    Daniela Alterio

  11. Radiation Oncology, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy

    Ester Orlandi

  12. Department of Radiation Oncology, S. Croce and Carle Teaching Hospital, Cuneo, Italy

    Anna Merlotti

  13. Department of Radiotherapy, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy

    Daniela Musio

Authors
  1. Francesco Dionisi
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  2. Alessia Di Rito
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  11. Francesca De Felice
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  13. Liliana Belgioia
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  16. Anna Merlotti
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  18. Giuseppe Sanguineti
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Contributions

Conceptualization was contributed by FD, ADR, AE and GI; software was contributed by FD, GI; data curation was contributed by all authors; writing—original draft preparation, was contributed by FD, ADR, AE and GI; supervision was contributed by FD, AM, DA, EO, DM and GS; writing, reviewing and editing, was contributed by all authors.

Corresponding author

Correspondence to Francesco Dionisi.

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The authors declare no conflict of interest.

Ethical standards

The study was conducted according to the guidelines of the Declaration of Helsinki. All the patient data were completely anonymized: The patient gave written informed consent for the study. The study was notified to and approved by the Institutional Review Board of the IRCCS Regina Elena Cancer Institute, protocol 15202 n.1792/22.

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Dionisi, F., Di Rito, A., Errico, A. et al. Nasopharyngeal cancer: the impact of guidelines and teaching on radiation target volume delineation. Radiol med 128, 362–371 (2023). https://doi.org/10.1007/s11547-023-01612-x

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