Contouring variation affects estimates of normal tissue complication probability for breast fibrosis after radiotherapy
Issued Date
2023-12-01
Resource Type
ISSN
09609776
eISSN
15323080
Scopus ID
2-s2.0-85170699959
Journal Title
Breast
Volume
72
Rights Holder(s)
SCOPUS
Bibliographic Citation
Breast Vol.72 (2023)
Suggested Citation
Jaikuna T., Osorio E.V., Azria D., Chang-Claude J., De Santis M.C., Gutiérrez-Enríquez S., van Herk M., Hoskin P., Lambrecht M., Lingard Z., Seibold P., Seoane A., Sperk E., Symonds R.P., Talbot C.J., Rancati T., Rattay T., Reyes V., Rosenstein B.S., de Ruysscher D., Vega A., Veldeman L., Webb A., West C.M.L., Aznar M.C. Contouring variation affects estimates of normal tissue complication probability for breast fibrosis after radiotherapy. Breast Vol.72 (2023). doi:10.1016/j.breast.2023.103578 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/90075
Title
Contouring variation affects estimates of normal tissue complication probability for breast fibrosis after radiotherapy
Author(s)
Author's Affiliation
Instituto de Investigación Sanitaria de Santiago de Compostela
Medizinische Fakultät Mannheim
Siriraj Hospital
College of Life Sciences
Vall d‘Hebron Institut de Oncologia
Université de Montpellier
Centro de Investigación Biomédica en Red de Enfermedades Raras
Universitair Ziekenhuis Gent
University of Leicester
KU Leuven
German Cancer Research Center
School of Medical Sciences
Icahn School of Medicine at Mount Sinai
Hospital Universitari Vall d'Hebron
Maastricht Universitair Medisch Centrum+
Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
Universitätsklinikum Hamburg-Eppendorf
Fondazione IRCCS Nazionale dei Tumori
Grupo de Medicina Xenómica (USC)
Medizinische Fakultät Mannheim
Siriraj Hospital
College of Life Sciences
Vall d‘Hebron Institut de Oncologia
Université de Montpellier
Centro de Investigación Biomédica en Red de Enfermedades Raras
Universitair Ziekenhuis Gent
University of Leicester
KU Leuven
German Cancer Research Center
School of Medical Sciences
Icahn School of Medicine at Mount Sinai
Hospital Universitari Vall d'Hebron
Maastricht Universitair Medisch Centrum+
Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
Universitätsklinikum Hamburg-Eppendorf
Fondazione IRCCS Nazionale dei Tumori
Grupo de Medicina Xenómica (USC)
Other Contributor(s)
Abstract
Background: Normal tissue complication probability (NTCP) models can be useful to estimate the risk of fibrosis after breast-conserving surgery (BCS) and radiotherapy (RT) to the breast. However, they are subject to uncertainties. We present the impact of contouring variation on the prediction of fibrosis. Materials and methods: 280 breast cancer patients treated BCS-RT were included. Nine Clinical Target Volume (CTV) contours were created for each patient: i) CTV_crop (reference), cropped 5 mm from the skin and ii) CTV_skin, uncropped and including the skin, iii) segmenting the 95% isodose (Iso95%) and iv) 3 different auto-contouring atlases generating uncropped and cropped contours (Atlas_skin/Atlas_crop). To illustrate the impact of contour variation on NTCP estimates, we applied two equations predicting fibrosis grade ≥ 2 at 5 years, based on Lyman-Kutcher-Burman (LKB) and Relative Seriality (RS) models, respectively, to each contour. Differences were evaluated using repeated-measures ANOVA. For completeness, the association between observed fibrosis events and NTCP estimates was also evaluated using logistic regression. Results: There were minimal differences between contours when the same contouring approach was followed (cropped and uncropped). CTV_skin and Atlas_skin contours had lower NTCP estimates (−3.92%, IQR 4.00, p < 0.05) compared to CTV_crop. No significant difference was observed for Atlas_crop and Iso95% contours compared to CTV_crop. For the whole cohort, NTCP estimates varied between 5.3% and 49.5% (LKB) or 2.2% and 49.6% (RS) depending on the choice of contours. NTCP estimates for individual patients varied by up to a factor of 4. Estimates from “skin” contours showed higher agreement with observed events. Conclusion: Contour variations can lead to significantly different NTCP estimates for breast fibrosis, highlighting the importance of standardising breast contours before developing and/or applying NTCP models.