Improving the accuracy of localisation in the radiotherapy treatment of head and neck, and brain cancer: some initial findings

Abstract

Aims: To investigate the impact on localisation of utilising contrast enhanced computed tomography (CT) scans and the formal input of a radiologist in the radiotherapy planning process.

Method: Ten head and neck / brain patients had pre- and post-contrast CT scans in the treatment position. Over several months, their unenhanced and enhanced scans were re-contoured by the original oncologist, and a radiologist. These new contours were compared to the original unenhanced contours and differences in contour volume, geographical position and tolerance doses on the associated PTVs were evaluated.

Results: The use of contrast lead to significant differences in the size of GTVs. Mean differences in GTVs of 32.8 % were significant at p=0.01. No significant impact on the position of the contour centre was noted. The impact of the radiologist lead to large differences in GTV (mean 20.5 %), but large SDs meant this result was not statistically significant. The contouring precision of the oncologist showed no significant difference for GTVs and PTVs.

Conclusions: The use of contrast when planning the radiotherapy treatment for head and neck / brain patients was found to lead to significant differences in GTV size, a lesser effect on PTV definition and little impact on the position of the contour centre. It may have important implications for multi-phase treatments where the GTV (rather than the PTV) is targeted for boost doses. Differences due to the input of a radiologist appear to be considerable and require further investigation when additional patient numbers have been acquired to improve precision.