For radiotherapy of prostate cancer, MRI is used increasingly for delineation of the prostate gland. For focal treatment of low-risk prostate cancer or focal dose escalation for intermediate and high-risk cancer, delineation of the tumor is also required.
While multi-parametric MRI is well established for detection of tumors and for staging of the disease, delineation of the tumor inside the prostate is not common practice. Guidelines, such as the PI-RADS classification, exist for tumor detection and staging, but no such guidelines are available for tumor delineation. Indeed, interobserver studies show substantial variation in tumor contours. Computer-aided tumor detection and delineation may help improve the robustness of the interpretation of multi-parametric MRI data. Comparing the performance of an earlier developed model for tumor segmentation with expert delineations, we found a significant correlation between tumor probability in a voxel and the number of experts identifying this voxel as tumor. This suggests that the model agrees with 'the wisdom of the crowd', and thus could serve as a reference for individual physicians in their decision making. With multi-parametric MRI it becomes feasible to revisit the GTV-CTV concept in radiotherapy of prostate cancer. While detection of index lesions is quite reliable, contouring variability and the low sensitivity to small lesions suggest that the remainder of the prostate should be treated as CTV. Clinical trials that investigate the options for dose differentiation, for example with dose escalation to the visible tumor or dose reduction to the CTV, are therefore warranted.
Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB). 2016 Feb 05 [Epub ahead of print]
Cuong V Dinh, Peter Steenbergen, Ghazaleh Ghobadi, Stijn W T J P Heijmink, Floris J Pos, Karin Haustermans, Uulke A van der Heide
Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands. , Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands. , Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands. , Department of Radiology, the Netherlands Cancer Institute, Amsterdam, The Netherlands. , Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands. , Department of Oncology, Radiation Oncology, University Hospitals Leuven, KU Leuven, Belgium. , Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands.