Abstract
PURPOSE: To explore the accuracy and feasibility of a proposed deep learning (DL) algorithm for clinical target volume (CTV) delineation in cervical cancer radiotherapy and evaluate whether it can perform well in external cervical cancer and endometrial cancer cases for generalization validation. METHODS: A total of 332 patients were enrolled in this study. A state-of-the-art network called ResCANet, which added the cascade multi-scale convolution in the skip connections to eliminate semantic differences between different feature layers based on ResNet-UNet. The atrous spatial pyramid pooling in the deepest feature layer combined the semantic information of different receptive fields without losing information. A total of 236 cervical cancer cases were randomly grouped into 5-fold cross-training (n = 189) and validation (n = 47) cohorts. External validations were performed in a separate cohort of 54 cervical cancer and 42 endometrial cancer cases. The performances of the proposed network were evaluated by dice similarity coefficient (DSC), sensitivity (SEN), positive predictive value (PPV), 95% Hausdorff distance (95HD), and oncologist clinical score when comparing them with manual delineation in validation cohorts. RESULTS: In internal validation cohorts, the mean DSC, SEN, PPV, 95HD for ResCANet achieved 74.8%, 81.5%, 73.5%, and 10.5 mm. In external independent validation cohorts, ResCANet achieved 73.4%, 72.9%, 75.3%, 12.5 mm for cervical cancer cases and 77.1%, 81.1%, 75.5%, 10.3 mm for endometrial cancer cases, respectively. The clinical assessment score showed that minor and no revisions (delineation time was shortened to within 30 min) accounted for about 85% of all cases in DL-aided automatic delineation. CONCLUSIONS: We demonstrated the problem of model generalizability for DL-based automatic delineation. The proposed network can improve the performance of automatic delineation for cervical cancer and shorten manual delineation time at no expense to quality. The network showed excellent clinical viability, which can also be even generalized for endometrial cancer with excellent performance.