Consensus recommendations for radiation therapy contouring and treatment of vulvar carcinoma

David K. Gaffney, Bronwyn King, Akila N. Viswanathan, Maroie Barkati, Sushil Beriwal, Patricia Eifel, Beth Erickson, Anthony Fyles, Jennifer Goulart, Matthew Harkenrider, Anuja Jhingran, Ann Klopp, Wui Jin Koh, Karen Lim, Ivy Petersen, Lorraine Portelance, William Small, Alexandra Stewart, Ericka Wiebe, Aaron WolfsonCatheryn Yashar, Walter Bosch

Research output: Contribution to journalArticlepeer-review

71 Scopus citations


Purpose The purpose of this study was to develop a radiation therapy (RT) contouring atlas and recommendations for women with postoperative and locally advanced vulvar carcinoma. Methods and Materials An international committee of 35 expert gynecologic radiation oncologists completed a survey of the treatment of vulvar carcinoma. An initial set of recommendations for contouring was discussed and generated by consensus. Two cases, 1 locally advanced and 1 postoperative, were contoured by 14 physicians. Contours were compared and analyzed using an expectation-maximization algorithm for simultaneous truth and performance level estimation (STAPLE), and a 95% confidence interval contour was developed. The level of agreement among contours was assessed using a kappa statistic. STAPLE contours underwent full committee editing to generate the final atlas consensus contours. Results Analysis of the 14 contours showed substantial agreement, with kappa statistics of 0.69 and 0.64 for cases 1 and 2, respectively. There was high specificity for both cases (≥99%) and only moderate sensitivity of 71.3% and 64.9% for cases 1 and 2, respectively. Expert review and discussion generated consensus recommendations for contouring target volumes and treatment for postoperative and locally advanced vulvar cancer. Conclusions These consensus recommendations for contouring and treatment of vulvar cancer identified areas of complexity and controversy. Given the lack of clinical research evidence in vulvar cancer radiation therapy, the committee advocates a conservative and consistent approach using standardized recommendations.

Original languageEnglish
Pages (from-to)1191-1200
Number of pages10
JournalInternational Journal of Radiation Oncology Biology Physics
Issue number4
StatePublished - Jul 15 2016


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