Abstract：
Background: Several reports have suggested that radiotherapy after reconstructive surgery for head and neck cancer (HNC), could have deleterious effects on the flaps with respect to functional outcomes. To predict and prevent toxicities, flap delineation should be accurate and reproducible. The objective of the present study was to evaluate the interobserver variability of frequent types of flaps used in HNC, based on the recent GORTEC atlas.Materials and methods: Each member of an international working group (WG) consisting of 14 experts delineated the flaps on a CT set from six patients. Each patient had one of the five most commonly used flaps in HNC: a regional pedicled pectoralis major myocutaneous flap, a local pedicled rotational soft tissue facial artery musculo-mucosal (FAMM) (2 patients), a fasciocutaneous radial forearm free flap, a soft tissue anterolateral thigh (ALT) free flap, or a fibular free flap. The WG\'s contours were compared to a reference contour, validated by a surgeon and a radiologist specializing in HNC. Contours were considered as reproducible if the median Dice Similarity Coefficient (DSC) was > 0.7.Results: The median volumes of the six flaps delineated by the WG were close to the reference contour value, with approximately 50 cc for the pectoral, fibula, and ALT flaps, 20 cc for the radial forearm, and up to 10 cc for the FAMM. The volumetric ratio was thus close to the optimal value of 100% for all flaps. The median DSC obtained by the WG compared to the reference for the pectoralis flap, the FAMM, the radial forearm flap, ALT flap, and the fibular flap were 0.82, 0.40, 0.76, 0.81, and 0.76, respectively.Conclusions: This study showed that the delineation of four main flaps used for HNC was reproducible. The delineation of the FAMM, however, requires close cooperation between radiologist, surgeon and radiation oncologist because of the poor visibility of this flap on CT and its small size.
摘要：
背景：一些报道表明，头颈部癌症（HNC）的重建手术后放疗，可能会对皮瓣的功能结果产生有害影响。为了预测和预防毒性，皮瓣勾画应准确且可重复。本研究的目的是评估HNC中使用的频繁类型的皮瓣的观察者间变异性。基于最近的GORTEC地图集。材料和方法：由14名专家组成的国际工作组（WG）的每个成员在六名患者的CT上描绘了皮瓣。每位患者都有HNC中最常用的五种皮瓣之一：区域性带蒂胸大肌肌皮瓣，局部带蒂旋转软组织面部动脉肌粘膜（FAMM）（2例），前臂桡骨游离筋膜皮瓣，软组织股前外侧（ALT）游离皮瓣，或者腓骨游离皮瓣.将WG的轮廓与参考轮廓进行了比较，由外科医生和专门从事HNC的放射科医生验证。如果中值骰子相似系数(DSC)>0.7,则认为轮廓是可再现的。结果：WG描绘的六个皮瓣的中位体积接近参考轮廓值，胸肌大约50毫升，腓骨,和ALT襟翼，20cc用于桡骨前臂，和高达10cc的FAMM。因此,对于所有襟翼,体积比接近100%的最佳值。WG获得的中值DSC与胸肌瓣的参考值相比，FAMM,前臂桡侧皮瓣,ALT襟翼,腓骨瓣分别为0.82、0.40、0.76、0.81和0.76。结论：这项研究表明，用于HNC的四个主要皮瓣的勾画是可重复的。FAMM的划定，然而,需要放射科医生之间的密切合作,外科医生和放射肿瘤学家，因为这种皮瓣在CT上的可见度低，尺寸小。
