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NRG brain tumor specialists consensus guidelines for glioblastoma contouring

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Abstract

Introduction

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. This study proposes consensus CTV guidelines, with a focus on areas of controversy while highlighting common errors in glioblastoma target delineation.

Methods

Ten academic radiation oncologists specializing in brain tumor treatment contoured CTVs on four glioblastoma cases. CTV expansions were based on NRG trial guidelines. Contour consensus was assessed and summarized by kappa statistics. A meeting was held to discuss the mathematically averaged contours and form consensus contours and recommendations.

Results

Contours of the cavity plus enhancement (mean kappa 0.69) and T2-FLAIR signal (mean kappa 0.74) showed moderate to substantial agreement. Experts were asked to trim off anatomic barriers while respecting pathways of spread to develop their CTVs. Submitted CTV_4600 (mean kappa 0.80) and CTV_6000 (mean kappa 0.81) contours showed substantial to near perfect agreement. Simultaneous truth and performance level estimation (STAPLE) contours were then reviewed and modified by group consensus. 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. Areas for close scrutiny of target delineation were described, with accompanying recommendations.

Conclusions

Consensus contouring guidelines were established based on expert contours. Careful delineation of anatomic pathways and barriers to spread can spare radiation to uninvolved tissue without compromising target coverage. Further study is necessary to accurately define optimal target volumes beyond isometric expansion techniques for individual patients.

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Funding

WRB’s work on this project was supported by a grant from National Institutes of Health Grant No. U24 CA180803,”Imaging and Radiation Oncology (IROC) Group”, David Followill, PI.

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Author notes

  1. Tim J. Kruser and Walter R. Bosch were responsible for statistical analyses.

Authors and Affiliations

  1. Department of Radiation Oncology, Northwestern Memorial Hospital, 251 E Huron St, LC-178, Galter Pavilion, Chicago, IL, 60611, USA

    Tim J. Kruser & Sean Sachdev

  2. Department of Radiation Oncology, Washington University, St. Louis, MO, USA

    Walter R. Bosch, Shahed N. Badiyan & Christina Tsien

  3. Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA

    Joseph A. Bovi

  4. Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

    Amol J. Ghia

  5. Department of Radiation Oncology, University of Michigan Hospital, Ann Arbor, MI, USA

    Michelle M. Kim

  6. Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA

    Abhishek A. Solanki

  7. Department of Radiation Oncology, Columbia University Medical Center, New York, NY, USA

    Tony J. C. Wang

  8. Miami Cancer Institute, Miami, FL, USA

    Minesh P. Mehta

  9. Columbus Regional Health, Columbus, IN, USA

    Kevin P. McMullen

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  1. Tim J. Kruser
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Corresponding author

Correspondence to Tim J. Kruser.

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Conflict of interest

WRB’s reports travel expenses from AAPM, and honoraria from Augmenix Inc. These do not pertain to this work and WRB declares he has no conflict of interest with regard to this study. 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 TJK declares he has no conflict of interest with regard to this study. CT is on a speaker’s bureau for Merck and Varian Medical Systems, advisory board for Novocure. These do not pertain to this work and CT declares she 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 TJCW 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 MPM declares he has no conflict of interest with regard to this study. KPM has served as a consultant for Via Oncology Pathways; this does not pertain to this work and KPM declares he has no conflict of interest with regard to this study. MMK reports a research grant from EpicentRX, which does not pertain to this work and MMK declares she has no conflict of interest with regard to this study. AAS has participated in an advisory committee, received travel expenses, received honoraria, and received research funding from Blue Earth Diagnostics, as well as travel expenses and honoraria from DAVA Oncology; this does not pertain to this work and AAS declares he has no conflict of interest with regard to this study. SNB, JAB, AJG, SS do not have relevant financial relationships to disclose and declare they have no conflicts of interest with regard to this study.

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Kruser, T.J., Bosch, W.R., Badiyan, S.N. et al. NRG brain tumor specialists consensus guidelines for glioblastoma contouring. J Neurooncol 143, 157–166 (2019). https://doi.org/10.1007/s11060-019-03152-9

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  • DOI: https://doi.org/10.1007/s11060-019-03152-9

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