Evaluation of variability in target volume delineation for newly diagnosed glioblastoma: A multi-institutional study from the Korean Radiation Oncology Group

Background: This study aimed for a collaborative evaluation of variability in the target volumes for glioblastoma, determined and contoured by different radiotherapy (RT) facilities in Korea. Methods: Fifteen panels of radiation oncologists from independent institutions contoured the gross target volumes (GTVs) and clinical target volumes (CTVs) for 3-dimensional conformal RT or intensity-modulated RT on each simulation CT images, after scrutinizing the enhanced T1-weighted and T2-weighted-fluid-attenuated inversion recovery MR images of 9 different cases of glioblastoma. Degrees of contouring agreement were analyzed by the kappa statistics. Using the algorithm of simultaneous truth and performance level estimation (STAPLE), GTV_STAPLE and CTV_STAPLE contours were derived. Results: Contour agreement was moderate (mean kappa 0.58) among the GTVs and was substantial (mean kappa 0.65) among the CTVs. However, each panels' GTVs and modification of CTVs regarding anatomical structures varied. Three-fourth of contoured panels' CTVs encompassed the peritumoral areas of T2-high signal intensity (T2-HSI). Nine of nine GTV_STAPLE encompased the surgical cavity and the T1-enhanced lesions. Eight of nine CTV_STAPLE encompassed the peritumoral T2-HSI area. The median MARGIN₉₀ and the median MARGIN₉₅ were 1.4 cm and 1.5 cm, respectively. Conclusions: Moderate to substantial agreement existed in target volumes for 3-dimensional or intensity-modulated RT determined by radiation oncologists in Korea. According to the estimated consensus contours, the initial CTV encompassed the GTV with margin less than 2.0 cm and the whole peritumoral areas of T2-HSI. The findings of our study propose the need for further studies and modified guidelines.