@article {Kim2021.02.24.21252123,
	author = {Kim, Jun Won and Marsilla, Joseph and Kazmierski, Michal and Tkachuk, Denis and Huang, Shao Hui and Xu, Wei and Cho, John and Ringash, Jolie and Bratman, Scott and Haibe-Kains, Benjamin and Hope, Andrew},
	title = {Development of web-based quality-assurance tool for radiotherapy target delineation for head and neck cancer: quality evaluation of nasopharyngeal carcinoma},
	elocation-id = {2021.02.24.21252123},
	year = {2021},
	doi = {10.1101/2021.02.24.21252123},
	publisher = {Cold Spring Harbor Laboratory Press},
	abstract = {Purpose We developed QUANNOTATE, a new web-application for rapid review of radiotherapy (RT) target volumes, and used it to evaluate the relationship between target delineation compliance with the international guidelines and treatment outcomes in nasopharyngeal carcinoma (NPC) patients undergoing definitive RT.Methods and Materials The dataset used for this study consists of anonymized CT simulation scans, RT structures, and clinical data of 332 pathologically confirmed NPC patients treated with intensity-modulated RT between July 2005 and August 2017. We imported the contours of intermediate risk clinical target volumes of the primary tumor (IR-CTVp) receiving 56 Gy into QUANNOTATE. We determined inclusion of anatomic sites within IR-CTVp in accordance with 2018 International guideline for CTV delineation for NPC and correlated the results with time to local failure (TTLF) using Cox-regression.Results At a median follow-up of 5.6 years, 5-year TTLF and overall survival rates were 93.1\% and 85.9\% respectively. The most frequently non-guideline compliant anatomic sites were sphenoid sinus (n = 69, 20.8\%), followed by cavernous sinus (n = 38, 19.3\%), left and right petrous apices (n = 37 and 32, 11.1\% and 9.6\%), clivus (n = 14, 4.2\%), and right and left foramen rotundum (n = 14 and 12, 4.2\% and 3.6\%). Among 23 patients with a local failure (6.9\%), the number of non-compliant cases were 8 for sphenoid sinus, 7 cavernous sinus, 4 left and 3 right petrous apices, and 2 clivus. Compared to conforming cases, cases which did not contour the cavernous sinus had a higher local failure (LF) rate (89.1\% vs 93.6\%, p= 0.013). Multivariable analysis confirmed that lack of cavernous sinus contouring was prognostic for LF.Conclusions QUANNOTATE allowed rapid review of target volumes in a large patient cohort. Despite an overall high compliance with the international guidelines, undercoverage of the cavernous sinus was correlated with LF.Competing Interest StatementThe authors have declared no competing interest.Funding StatementThis work was supported by Canadian Institutes of Health Research (CIHR) Project $\#$426366 and the National Research Foundation of Korea (NRF) grant funded by the Korean Government Ministry of Science and ICT (NRF-2020R1A2C1102559).Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:This study was approved by the Health Canada and Public Health Agency of Canada (PHAC) Research Ethics Board (REB, approval $\#$17-5871).All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesThe web-based application, QUANNOTAE, is available at https://www.quannotate.com, and all preprocessing scripts used to build the application are available at https://github.com/bhklab/quannotate. https://github.com/bhklab/quannotate https://www.quannotate.com},
	URL = {https://www.medrxiv.org/content/early/2021/02/26/2021.02.24.21252123},
	eprint = {https://www.medrxiv.org/content/early/2021/02/26/2021.02.24.21252123.full.pdf},
	journal = {medRxiv}
}