% IMPORTANT: The following is UTF-8 encoded.  This means that in the presence
% of non-ASCII characters, it will not work with BibTeX 0.99 or older.
% Instead, you should use an up-to-date BibTeX implementation like “bibtex8” or
% “biber”.

@ARTICLE{Jaikuna:282898,
      author       = {T. Jaikuna and E. V. Osorio and D. Azria and J.
                      Chang-Claude$^*$ and M. C. De Santis and S.
                      Gutiérrez-Enríquez and M. van Herk and P. Hoskin and M.
                      Lambrecht and Z. Lingard and P. Seibold$^*$ and A. Seoane
                      and E. Sperk and R. P. Symonds and C. J. Talbot and T.
                      Rancati and T. Rattay and V. Reyes and B. S. Rosenstein and
                      D. de Ruysscher and A. Vega and L. Veldeman and A. Webb and
                      C. M. L. West and M. C. Aznar},
      title        = {{C}ontouring variation affects estimates of normal tissue
                      complication probability for breast fibrosis after
                      radiotherapy.},
      journal      = {The breast},
      volume       = {72},
      issn         = {0960-9776},
      address      = {Amsterdam [u.a.]},
      publisher    = {Elsevier},
      reportid     = {DKFZ-2023-01891},
      pages        = {103578},
      year         = {2023},
      abstract     = {Normal tissue complication probability (NTCP) models can be
                      useful to estimate the risk of fibrosis after
                      breast-conserving surgery (BCS) and radiotherapy (RT) to the
                      breast. However, they are subject to uncertainties. We
                      present the impact of contouring variation on the prediction
                      of fibrosis.280 breast cancer patients treated BCS-RT were
                      included. Nine Clinical Target Volume (CTV) contours were
                      created for each patient: i) $CTV_crop$ (reference), cropped
                      5 mm from the skin and ii) $CTV_skin,$ uncropped and
                      including the skin, iii) segmenting the $95\%$ isodose
                      $(Iso95\%)$ and iv) 3 different auto-contouring atlases
                      generating uncropped and cropped contours
                      $(Atlas_skin/Atlas_crop).$ To illustrate the impact of
                      contour variation on NTCP estimates, we applied two
                      equations predicting fibrosis grade ≥ 2 at 5 years, based
                      on Lyman-Kutcher-Burman (LKB) and Relative Seriality (RS)
                      models, respectively, to each contour. Differences were
                      evaluated using repeated-measures ANOVA. For completeness,
                      the association between observed fibrosis events and NTCP
                      estimates was also evaluated using logistic regression.There
                      were minimal differences between contours when the same
                      contouring approach was followed (cropped and uncropped).
                      $CTV_skin$ and $Atlas_skin$ contours had lower NTCP
                      estimates $(-3.92\%,$ IQR 4.00, p < 0.05) compared to
                      $CTV_crop.$ No significant difference was observed for
                      $Atlas_crop$ and $Iso95\%$ contours compared to $CTV_crop.$
                      For the whole cohort, NTCP estimates varied between $5.3\%$
                      and $49.5\%$ (LKB) or $2.2\%$ and $49.6\%$ (RS) depending on
                      the choice of contours. NTCP estimates for individual
                      patients varied by up to a factor of 4. Estimates from
                      'skin' contours showed higher agreement with observed
                      events.Contour variations can lead to significantly
                      different NTCP estimates for breast fibrosis, highlighting
                      the importance of standardising breast contours before
                      developing and/or applying NTCP models.},
      keywords     = {Breast cancer (Other) / Fibrosis (Other) / Inter-observer
                      variation (Other) / Late effects (Other) / NTCP modelling
                      (Other) / Radiotherapy (Other)},
      cin          = {C020},
      ddc          = {610},
      cid          = {I:(DE-He78)C020-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:37713940},
      doi          = {10.1016/j.breast.2023.103578},
      url          = {https://inrepo02.dkfz.de/record/282898},
}