Improved dosimetric accuracy with semi-automatic contour propagation of organs-at-risk in glioblastoma patients undergoing chemoradiation.

ABSTRACT

BACKGROUND: We study the changes in organs-at-risk (OARs) morphology as contoured on serial MRIs during chemoradiation therapy (CRT) of glioblastoma (GBM). The dosimetric implication of assuming non-deformable OAR changes and the accuracy and feasibility of semi-automatic OAR contour propagation are investigated. METHODS: Fourteen GBM patients who were treated with adjuvant CRT for GBM prospectively underwent MRIs on fractions 0 (i.e., planning), 10, 20, and 1 month post last fraction of CRT. Three sets of OAR contours - (a) manual, (b) rigidly registered (static), and (c) semi-automatically propagated - were compared using Dice similarity coefficient (DSC) and Hausdorff distance (HD). Dosimetric impact was determined by comparing the minimum dose to the 0.03 cc receiving the highest dose (D0.03 cc) on a clinically approved reference, non-adapted radiation therapy plan. RESULTS: The DSC between the manual contours and the static contours decreased significantly over time (fraction 10 [mean ± 1 SD] 0.78 ± 0.17, post 1 month 0.76 ± 0.17, P = 0.02) while the HD (P = 0.74) and the difference in D0.03cc did not change significantly (P = 0.51). Using the manual contours as reference, compared to static contours, propagated contours have a significantly higher DSC (propagated [mean ± 1 SD] 0.81 ± 0.15, static 0.77 ± 0.17, P < 0.001), lower HD (propagated 3.77 ± 1.8 mm, static 3.96 ± 1.6 mm, P = 0.002), and a significantly lower absolute difference in D0.03cc (propagated 101 ± 159 cGy, static 136 ± 243 cGy, P = 0.019). CONCLUSIONS: Nonrigid changes in OARs over time lead to different maximum doses than planned. By using semi-automatic OAR contour propagation, OARs are more accurately delineated on subsequent fractions, with corresponding improved accuracy of the reported dose to the OARs.