Evidence map›Paper›PMID 27089966›Full record

ArticleRadiation oncology (London, England)2016

Variability in spine radiosurgery treatment planning - results of an international multi-institutional study.

André Toussaint, Anne Richter, Frederick Mantel, John C Flickinger, Inga Siiner Grills, Neelam Tyagi, Arjun Sahgal, Daniel Letourneau, Jason P Sheehan, David J Schlesinger and 2 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Radiation oncology (London, England), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

André ToussaintDepartment of Radiation Oncology, University of Wuerzburg, Wuerzburg, Germany. toussaint_a@ukw.de.
Anne RichterDepartment of Radiation Oncology, University of Wuerzburg, Wuerzburg, Germany.
Frederick MantelDepartment of Radiation Oncology, University of Wuerzburg, Wuerzburg, Germany.
John C FlickingerDepartments of Neurological Surgery and Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Inga Siiner GrillsWilliam Beaumont Hospital, Royal Oak, MI, USA.
Neelam TyagiWilliam Beaumont Hospital, Royal Oak, MI, USA.
Arjun SahgalDepartment of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada.
Daniel LetourneauPrincess Margaret Cancer Center, Toronto, ON, Canada.
Jason P SheehanUniversity of Virginia School of Medicine, Charlottesville, VA, USA.
David J SchlesingerUniversity of Virginia School of Medicine, Charlottesville, VA, USA.
Peter Carlos GersztenDepartments of Neurological Surgery and Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Matthias GuckenbergerDepartment of Radiation Oncology, University of Wuerzburg, Wuerzburg, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe aim of this study was to quantify the variability in spinal radiosurgery (SRS) planning practices between five international institutions, all member of the Elekta Spine Radiosurgery Research Consortium.

methodsFour institutions provided one representative patient case each consisting of the medical history, CT and MR imaging. A step-wise planning approach was used where, after each planning step a consensus was generated that formed the basis for the next planning step. This allowed independent analysis of all planning steps of CT-MR image registration, GTV definition, CTV definition, PTV definition and SRS treatment planning. In addition, each institution generated one additional SRS plan for each case based on intra-institutional image registration and contouring, independent of consensus results.

resultsAveraged over the four cases, image registration variability ranged between translational 1.1 mm and 2.4 mm and rotational 1.1° and 2.0° in all three directions. GTV delineation variability was 1.5 mm in axial and 1.6 mm in longitudinal direction averaged for the four cases. CTV delineation variability was 0.8 mm in axial and 1.2 mm in longitudinal direction. CTV-to-PTV margins ranged between 0 mm and 2 mm according to institutional protocol. Delineation variability was 1 mm in axial directions for the spinal cord. Average PTV coverage for a single fraction18 Gy prescription was 87 ± 5 %; Dmin to the PTV was 7.5 ± 1.8 Gy averaged over all cases and institutions. Average Dmax to the PRV_SC (spinal cord + 1 mm) was 10.5 ± 1.6 Gy and the average Paddick conformity index was 0.69 ± 0.06.

conclusionsResults of this study reflect the variability in current practice of spine radiosurgery in large and highly experienced academic centers. Despite close methodical agreement in the daily workflow, clinically significant variability in all steps of the treatment planning process was demonstrated. This may translate into differences in patient clinical outcome and highlights the need for consensus and established delineation and planning criteria.

Indexed as

FemaleHumansImage Processing, Computer-AssistedInternational CooperationMagnetic Resonance ImagingMaleMiddle AgedMultimodal ImagingOrgans at RiskRadiometryRadiosurgeryRadiotherapy Planning, Computer-AssistedReproducibility of ResultsSpinal CordSpinal NeoplasmsTomography, X-Ray ComputedDelineationPlanning variabilitySpine radiosurgeryVertebral metastases

Identifiers

PMID27089966
PMCPMC4835862

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