Cancer Res Treat.  2019 Jul;51(3):1001-1010. 10.4143/crt.2018.415.

Dummy Run of Quality Assurance Program before Prospective Study of Hippocampus-Sparing Whole-Brain Radiotherapy and Simultaneous Integrated Boost for Multiple Brain Metastases from Non-small Cell Lung Cancer: Korean Radiation Oncology Group (KROG) 17-06 Study

• Chung E
• Noh JM
• Lee KC
• Kim JH
• Chung WK
• Suh YG
• Lee JA
• Seol KH
• Wu HG
• Kim YS
• Noh OK
• Park JW
• Lee DS
• Lee J
• Kim YS
• Park WY
• Kang MK
• Jo S
• Ahn YC

• KMID: 2454292
• DOI: http://doi.org/10.4143/crt.2018.415

Abstract

PURPOSE
Lung Cancer Subcommittee of Korean Radiation Oncology Group (KROG) has recently launched a prospective clinical trial (KROG 17-06) of hippocampus-sparing whole brain radiotherapy (HS-WBRT) with simultaneous integrated boost (SIB) in treating multiple brain metastases from non-small cell lung cancer. In order to improve trial quality, dummy run studies among the participating institutions were designed. This work reported the results of two-step dummy run procedures of the KROG 17-06 study.
MATERIALS AND METHODS
Two steps tested hippocampus contouring variability and radiation therapy planning compliance. In the first step, the variation of the hippocampus delineation was investigated for two representative cases using the Dice similarity coefficients. In the second step, the participating institutions were requested to generate a HS-WBRT with SIB treatment plan for another representative case. The compliance of the treatment plans to the planning protocol was evaluated.
RESULTS
In the first step, the median Dice similarity coefficients of the hippocampus contours for two other dummy run cases changed from 0.669 (range, 0.073 to 0.712) to 0.690 (range, 0.522 to 0.750) and from 0.291 (range, 0.219 to 0.522) to 0.412 (range, 0.264 to 0.598) after providing the hippocampus contouring feedback. In the second step, with providing additional plan priority and extended dose constraints to the target volumes and normal structures, we observed the improved compliance of the treatment plans to the planning protocol.
CONCLUSION
The dummy run studies demonstrated the notable inter-institutional variability in delineating the hippocampus and treatment plan generation, which could be decreased through feedback from the trial center.

Keyword

Hippocampus-sparing whole brain radiotherapy; Dummy run; Multi-institutional study; QA program; Non-small cell lung cancer

MeSH Terms

Brain*
Carcinoma, Non-Small-Cell Lung*
Compliance
Hippocampus
Lung Neoplasms
Neoplasm Metastasis*
Prospective Studies*
Radiation Oncology*
Radiotherapy*

Figure

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  Fig. 1. Hippocampus delineation in a computed tomography image for patient A before (A) and after providing the hippocampus contouring feedback (B). (C) Change of hippocampus volume-to-reference volume ratio delineated by each participating institution. (D) Dice similarity coefficients before and after providing the feedback in the scatter plots with median lines. (E, F) The inter-institutional variation of the dose distributions to the delineated hippocampus contours from reference dose distribution before and after providing the feedback, respectively.

• 

  Fig. 2. Hippocampus delineation in a computed tomography image for patient B before (A) and after providing the hippocampus contouring feedback (B). (C) Change of hippocampus volume-to-reference volume ratio delineated by each participating institution. (D) Dice similarity coefficients before and after providing the feedback in the scatter plots with median lines. (E, F) The inter-institutional variation of the dose distributions to the delineated hippocampus contours from an identical radiation dose distribution before and after providing the feedback, respectively.

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  Fig. 3. Gross tumor volume (GTV) (A) and hippocampus delineation (B) in a computed tomography image for patient C. (C) Contoured volume-to-reference volume ratio delineated by each participating institution. (D) Dice similarity coefficients of GTV, planning gross tumor volume (P-GTV) and hippocampus in the scatter plots with median lines. (E) Inter-institutional variation of the dose distribution to the P-GTV and hippocampus contours from a reference radiation dose distribution provided from the trial center. (F) Dose-volume histograms for P-GTV, planning clinical target volume (P-CTV) and hippocampus contours from the 12 dummy run treatment plans for patient C. Each treatment plan was generated based on the two target volumes (P-GTV and P-CTV), hippocampus and other normal structures which were delineated by each participating institution.

Reference

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