Proposal for the delineation of neoadjuvant target volumes in oesophageal cancer

M. Thomas*, H.R. Mortensen, L. Hoffmann, D.S. Moller, E.G.C. Troost, C.T. Muijs, M. Berbee, R. Butof, O. Nicholas, G. Radhakrishna, G. Defraene, P. Nafteux, M. Nordsmark, K. Haustermans

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Purpose: To define instructions for delineation of target volumes in the neoadjuvant setting in oesophageal cancer.

Materials and methods: Radiation oncologists of five European centres participated in the following consensus process: [1] revision of published (MEDLINE) and national/institutional delineation guidelines; [2] first delineation round of five cases (patient 1-5) according to national/institutional guidelines; [3] consensus meeting to discuss the results of step 1 and 2, followed by a target volume delineation proposal; [4] circulation of proposed instructions for target volume delineation and atlas for feedback; [5] second delineation round of five new cases (patient 6-10) to peer review and validate (two additional centres) the agreed delineation guidelines and atlas; [6] final consensus on the delineation guidelines depicted in an atlas.

Target volumes of the delineation rounds were compared between centres by Dice similarity coefficient (DSC) and maximum/mean undirected Hausdorff distances (H-max/H-mean).

Results: In the first delineation round, the consistency between centres was moderate (CTVtotal: DSC = 0. 59-0.88; H-mean = 0.2-0.4 cm). Delineations in the second round were much more consistent. Lowest variability was obtained between centres participating in the consensus meeting (CTVtotal: DSC: p < 0.050 between rounds for patients 6/7/8/10; H-mean: p < 0.050 for patients 7/8/10), compared to validation centres (CTVtotal: DSC: p < 0.050 between validation and consensus meeting centres for patients 6/7/8; H-mean: p < 0.050 for patients 7/10). A proposal for delineation of target volumes and an atlas were generated.

Conclusion: We proposed instructions for target volume delineation and an atlas for the neoadjuvant radiation treatment in oesophageal cancer. These will enable a more uniform delineation of patients in clinical practice and clinical trials. (C) 2020 Elsevier B.V. All rights reserved.

Original languageEnglish
Pages (from-to)102-112
Number of pages11
JournalRadiotherapy and Oncology
Publication statusPublished - 1 Mar 2021


  • Consensus
  • Delineation atlas
  • Neoadjuvant chemoradiation
  • Oesophageal cancer
  • Proposal for delineation


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