Abstract

ABSTRACTThis study aimed to examine the efficacy of semantic segmentation implemented by deep learning and to confirm whether this method is more effective than a commercially dominant auto-segmentation tool with regards to delineating normal lung excluding the trachea and main bronchi. A total of 232 non-small-cell lung cancer cases were examined. The computed tomography (CT) images of these cases were converted from Digital Imaging and Communications in Medicine (DICOM) Radiation Therapy (RT) formats to arrays of 32 × 128 × 128 voxels and input into both 2D and 3D U-Net, which are deep learning networks for semantic segmentation. The number of training, validation and test sets were 160, 40 and 32, respectively. Dice similarity coefficients (DSCs) of the test set were evaluated employing Smart SegmentationⓇ Knowledge Based Contouring (Smart segmentation is an atlas-based segmentation tool), as well as the 2D and 3D U-Net. The mean DSCs of the test set were 0.964 [95% confidence interval (CI), 0.960–0.968], 0.990 (95% CI, 0.989–0.992) and 0.990 (95% CI, 0.989–0.991) with Smart segmentation, 2D and 3D U-Net, respectively. Compared with Smart segmentation, both U-Nets presented significantly higher DSCs by the Wilcoxon signed-rank test (P < 0.01). There was no difference in mean DSC between the 2D and 3D U-Net systems. The newly-devised 2D and 3D U-Net approaches were found to be more effective than a commercial auto-segmentation tool. Even the relatively shallow 2D U-Net which does not require high-performance computational resources was effective enough for the lung segmentation. Semantic segmentation using deep learning was useful in radiation treatment planning for lung cancers.

Highlights

  • Lung cancer is the most common malignancy in both men and women

  • According to the National Comprehensive Cancer Network (NCCN) guidelines, chemoradiation therapy is recommended for unresectable stage II and III non-small cell lung cancer (NSCLC), and stereotactic body radiotherapy for unresectable early stage NSCLC [3]

  • The Radiation Therapy Oncology Group (RTOG) 1106 contouring atlas guideline recommends that gross tumor volume, the hilar portions of the lungs and the trachea/main bronchi not be included in the lung

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Summary

Introduction

Lung cancer is the most common malignancy in both men and women. In 2018, 1.8 million people died worldwide as a result of this disease, which is the most frequent cause of cancer-related deaths globally as well as in Japan [1, 2]. According to the National Comprehensive Cancer Network (NCCN) guidelines, chemoradiation therapy is recommended for unresectable stage II and III non-small cell lung cancer (NSCLC), and stereotactic body radiotherapy for unresectable early stage NSCLC [3]. Consolidation therapy with the anti-programmed death ligand 1 antibody durvalumab after concurrent chemoradiation therapy in unresectable stage III NSCLC was reported to significantly extend progression-free survival as compared to a placebo [4]. An increase in NSCLC patients undergoing radiation therapy is anticipated. Radiation pneumonitis is a common complication of radiation therapy in NSCLC patients.

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