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ON THE DEVELOPMENT OF TARGET VOLUME GUIDELINES IN EXTREMITY SARCOMAS;

ON THE DEVELOPMENT OF TARGET VOLUME GUIDELINES IN EXTREMITY SARCOMAS; WORK IN PROGRESS BY A TRANSATLANTIC RADIATION-ONCOLOGISTS TASK FORCE. Rick Haas NKI – AVL Amsterdam. TRANSATLANTIC RADIATION-ONCOLOGISTS TASK FORCE.

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ON THE DEVELOPMENT OF TARGET VOLUME GUIDELINES IN EXTREMITY SARCOMAS;

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  1. ON THE DEVELOPMENT OF TARGET VOLUME GUIDELINES IN EXTREMITY SARCOMAS; WORK IN PROGRESS BY A TRANSATLANTIC RADIATION-ONCOLOGISTS TASK FORCE. Rick Haas NKI – AVL Amsterdam

  2. TRANSATLANTIC RADIATION-ONCOLOGISTS TASK FORCE R.L.M. Haas, chair The Netherlands Cancer Institute, Amsterdam. J. Duppen research programmer B. O’Sullivan Princess Margaret Hospital, Toronto, Canada. Th. F. DeLaney Massachusetts General Hospital, Boston, USA. C. Le Pechoux Institute Gustav Roussy, Paris, France. P. Olmi Instituto di Tumori, Milan, Italy. R. Keus Arnhem’s Radiation Oncology Institute, Arnhem, The Netherlands

  3. Introduction For many irradiation regimens guidelines on the drawing of target volumes (TV) are available.

  4. Introduction; head and neck For many irradiation regimens guidelines on the drawing of target volumes (TV) are available. Proposal for the delineation of the nodal CTV in the node-positive and the post-operative neck Vincent Grégoire; Radiotherapy and Oncology 2006; 79 : 15-20.

  5. Introduction; pelvic nodes in gynecology For many irradiation regimens guidelines on the drawing of target volumes (TV) are available. Target volume definition for intensity modulated whole pelvic radiotherapy J. Staffurth; ASCO 2005 www.asco.org

  6. Introduction For many irradiation regimens guidelines on the drawing of target volumes (TV) are available. Guidelines in extremity sarcomas (ES) are lacking up to now.

  7. Introduction For many irradiation regimens guidelines on the drawing of target volumes (TV) are available. Guidelines in extremity sarcomas (ES) are lacking up to now. The EORTC develops a new phase III trial on pre- versus postoperative irradiation in ES patients. EORTC 62064 / 22064

  8. Introduction For many irradiation regimens guidelines on the drawing of target volumes (TV) are available. Guidelines in extremity sarcomas (ES) are lacking up to now. The EORTC develops a new phase III trial on pre- versus postoperative irradiation in ES patients. A task force is currently producing uniform guidelines for drawing TV in ES patients.

  9. Methods Experts in the field of radiotherapy in sarcomas were selected. A draft guideline was produced (by chair). A CD-ROM with 4 ES cases (2 pre-op, 2 post-op) containing the planning CT-scan 3-dimensional diagnostic MRI imaging patient characteristics drawing tool.

  10. Methods; volumes to be drawn. Pre-op cases: GTV, CTV and PTV Post-op cases: first-phase CTV and PTV boost CTV and PTV

  11. CD-ROM

  12. CD-ROM

  13. CD-ROM

  14. CD-ROM

  15. CD-ROM

  16. Phases of target volume guideline development 1st phase Concept guideline by chair 1st round CD a/ drawing according to concept guideline b/ any suggestions on the concept guideline

  17. Phases of target volume guideline development 1st phase Concept guideline by chair 1st round CD a/ drawing according to concept guideline => are RT’s able to produce uniform TV b/ any suggestions on the concept guideline

  18. Phases of target volume guideline development 1st phase Concept guideline by chair: drawing of the primary tumor = GTV

  19. Phases of target volume guideline development 1st phase Concept guideline by chair: drawing of the possible microscopic extensions = CTV

  20. Phases of target volume guideline development 1st phase Concept guideline by chair; drawing of the volume to be irradiated = PTV

  21. Phases of target volume guideline development 2nd phase 2nd round CD inter-observer variations intra-observer variations interval several months

  22. Phases of target volume guideline development 2nd phase 2nd round CD inter-observer variations intra-observer variations Interval several months 2nd version guideline margins concepts etc etc

  23. Phases of target volume guideline development 3rd phase Final version guideline 3rd round CD drawing of TV exactly according tofinal guideline interobserver variability

  24. First results Golden Rule: two doctors seldom agree on one subject I think we’ll need a third opinion. My computer and I seem to disagree.

  25. First results; agreement

  26. First results; disagreement Conformity index Observer A Observer B

  27. First results; disagreement Conformity index = common volume = encompassing volume Observer A Observer B

  28. First results; disagreement Conformity index = common volume = encompassing volume Observer A Observer B

  29. First results; disagreement Conformity index Ideal situation Poor situation common volume = “pure” GTV = zero cc encompassing volume = common volume = ~ 2x “pure” GTV

  30. First results; disagreement Conformity index Ideal situation Worst situation common volume = “pure” GTV = zero cc encompassing volume = common volume = ~ 2x “pure” GTV

  31. First results; disagreement;

  32. First results; disagreement; Conclusions volumes in post-op RT are much larger disagreement in post-op RT is much larger

  33. Thanks for your attention

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