正常组织概述四肢软组织肉瘤的发展指南

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology Pub Date : 2025-07-19 DOI:10.1016/j.ctro.2025.101020

Rita Simões , Sarah Gulliford , Punita Shah , Eve McAtavey , Elizabeth Richardson , Umme Chowdhury , Laura Fray , Roeum Butt , Yolanda Augustin , Ruqayyah Sarang , Refia Kilinc , Maryam Iqbal , Hakim Moulay-Dehbi , Elizabeth Miles , Peter Hoskin , Shane Zaidi , Kevin J Harrington , Aisha B. Miah

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引用次数: 0

摘要

针对肢体软组织肉瘤（STSE）的放射治疗（RT）计划进行了优化，以实现最大的目标覆盖，同时避免高剂量对负重骨骼和中等剂量对正常组织（NT）肢体走廊的影响。在这项研究中，基于使用这些指南和图谱进行放射治疗计划可能降低放射治疗毒性的假设，开发了新的下肢放射治疗指南和图谱。对指南的可用性和适用性进行了研究。方法制定NT概述指南。选择了两个STSE病例，并由一名放射治疗技师/放射治疗师（RTT）为每个病例概述了一套参考书，并由放射肿瘤学顾问（RO）进行了同行评审。然后分别由11名（8名RTT和3名RO）和12名（9名RTT和3名RO）额外观察员根据指南对病例1和2进行了nt概述。根据参考体积计算单个NT体积的骰子系数（Dice）、最大豪斯多夫距离（maxHD）和平均表面距离（MSD）。进行Kruskal-Wallis检验。然后使用观察者间可变性分析来告知指导改进。结果DICE、MSD和maxHD对前、后、内收肌室、臀肌室、股骨、股骨头、颈部、膝关节和髋关节的测量结果一致性好，重复性好。外旋肌室和髂腰肌室、股神经血管束和腹股沟股神经血管束观察到中度一致。大腿深层神经维管束的一致性较差。结论：我们的研究结果表明，新NT概述了STSE的指导方针，在观察者和多专业环境中具有可重复性，RTT和RO评分一致。这种可重复性归功于指南的使用。本研究还确定了指南需要改进的领域，特别是大腿深部神经血管束。

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Normal tissue outlining guidelines development for soft tissue sarcoma of the extremities

Introduction

Radiotherapy (RT) plans for soft tissue sarcoma of the extremities (STSE) are optimised to achieve maximum target coverage whilst avoiding high doses to weight-bearing bones and intermediate doses to the normal tissue (NT) limb corridor. Within this study, novel lower extremity NT outlining guidelines and atlas were developed based on the hypothesis that using these for RT planning may reduce RT toxicity. Usability and applicability of the guidance were also investigated.

Methods

Guidelines for NT outlining were developed. Two STSE cases were selected and a set of reference volumes was outlined on each case by one Therapeutic Radiographer/Radiation Therapist (RTT) and peer-reviewed by a consultant radiation oncologist (RO). NTs were then outlined following the guidelines by 11 (8 RTT and 3 RO) and 12 (9 RTT and 3 RO) additional observers, respectively for cases 1 and 2. Dice coefficient (DICE), Maximum Hausdorff distance (maxHD) and mean surface distance (MSD) were calculated for individual NT volumes against the reference volumes. The Kruskal-Wallis test was performed. Analysis of interobserver variability was then used to inform guidance improvement.

Results

Good agreement and reproducibility were observed in DICE, MSD and maxHD for the anterior, posterior, adductor and gluteal muscle compartments, femur and femoral head and neck, knee and hip joints. Moderate agreement was observed for the lateral rotator and iliopsoas muscle compartments, and the femoral and inguinofemoral neurovascular bundle. Poor agreement was observed for the deep thigh neurovascular bundle.

Conclusion

Our results identify that the new NT outlining guidance for STSE is reproducible between observers and within a multi-professional environment, with consistent RTT and RO scores. This reproducibility is attributed to the use of guidelines. This study has also identified areas for refinement of the guidelines, particularly for the deep thigh neurovascular bundle.

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