RESUMO
AIMS: The delineation of target volumes has been radiation oncologist led. If radiation therapists were to undertake this task, work processes may be more efficient and the skills set of radiation therapy staff broadened. This study was undertaken to quantify interobserver variability of breast target volumes between radiation oncologists and radiation therapists. MATERIALS AND METHODS: The planning computed tomography datasets of 30 patients undergoing tangential breast radiotherapy were utilised. Four radiation oncologists and four radiation therapists independently contoured the clinical target volume (CTV) of the breast on planning computed tomography using a written protocol. The mean CTV volumes and the mean distance between centres of volume (COV) were determined for both groups to determine intergroup variation. Each of the radiation oncologists' readings in turn has been used as the gold standard and compared with that of the radiation therapists. The concordance index for each patient's CTV was determined relative to the gold standard for each group. A paired t-test was used for statistical comparison between the groups. An intraclass correlation coefficient was calculated to measure the agreement between the radiation oncologist and radiation therapist groups. RESULTS: The mean concordance index was 0.81 for radiation oncologists and 0.84 for radiation therapists. The intraclass correlation coefficient for the mean volume was 0.995 (95% confidence interval 0.981-0.998) between radiation oncologist- and radiation therapist-contoured volumes. The intraclass correlation for the mean difference between radiation oncologists' and radiation therapists' COV was 0.999 (95% confidence interval 0.999-1.000). CONCLUSIONS: Interobserver variability between radiation oncologists and radiation therapists was found to be low. Radiation therapists could potentially assume the role of CTV voluming for breast radiotherapy provided a standardised contouring protocol is in place.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/radioterapia , Radioterapia (Especialidade) , Idoso , Neoplasias da Mama/patologia , Protocolos Clínicos , Feminino , Humanos , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estudos Prospectivos , Radiologia , Planejamento da Radioterapia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X , Carga TumoralRESUMO
Partial or complete limb salvage has been achieved in seven patients by the use of basal intraarterial infusion chemotherapy. All had either refused amputation or had been considered unsuitable for it. Results in all cases showed marked tumour regression to a size where local measures were then successful in controlling the disease. Six of the patients are alive and well with no sign of recurrence at periods ranging from four months to six years.