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ORIGINAL RESEARCH article
Front. Oncol.
Sec. Radiation Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1510568
Interobserver variability in organ delineation on radiotherapy treatment planning for nasopharyngeal carcinoma: A dosimetric and prognostic analysis
Provisionally accepted
Meining Chen1
Yinglin Peng1Ruotong Chen1Qiuying Xie2Dengyuan Chen3Jinping Shi2Rong Huang2
Jun Zhang1
Chong Zhao1
Li Chen1*
Xiaowu Deng1*
Yimei Liu1*- 1Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, China
- 2First People's Hospital of Foshan, Foshan, Guangdong Province, China
- 3Luoding People’s Hospital, Luoding, China
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Background and Purpose: This study aimed to analyze the impact of interobserver variability (IOV) on clinical dosimetry and prognosis, specifically investigating the correlation between IOV and clinical prognosis in the context of intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC).Twelve NPC patients who underwent IMRT were selected.Four radiotherapy physicians from two different-tier cancer centers independently delineated target volumes and organs at risk (OARs) for each patient. These delineations were compared against gold standard structures from a regional cancer center. The IOV among physicians and its effect on clinical and prognosis were analyzed. The relationships between the IOV, dosimetry, and prognosis were investigated using spearman's correlation analysis.The target volume and OARs delineation differed significantly among physicians. This variability led to reduced prescription dose coverage (PDC) of the planning target volume (PTV) and increased doses to OARs, impacting tumor control probability (TCP) and normal tissue complication probability (NTCP). Compared to standard delineations, all four physicians showed decreased TCPs (average decrease in ΔTCP >1%) and a significant increase in NTCPs of OARs. The relative volume difference (ΔV) of target volumes correlated strongly with ΔPDC (R=0.686) and ΔTCP (R=0.703). Moreover, in the validation set, ΔV also strongly correlated with ΔTCP (R = 0.778).: Substantial IOV in delineating NPC target volumes and OARs for IMRT was observed. This variability affects plan optimization, dose distribution, and clinical prognosis. ΔV can serve as a risk predictor for assessing delineation variability in NPC radiotherapy treatment planning. * Indicates significant differences when comparing city or county-level cancer center protocols to the standard protocol, with ** indicating P<0.01 and * indicating P<0.05.
Keywords: intensity-modulated radiotherapy, interobserver variability, Normal tissue complication probability, tumor control probability, nasopharyngeal carcinoma TMJ, temporomandibular joint; TP lobe, Temporal Lobe
Received: 13 Oct 2024; Accepted: 18 Apr 2025.
Copyright: © 2025 Chen, Peng, Chen, Xie, Chen, Shi, Huang, Zhang, Zhao, Chen, Deng and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Li Chen, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, China
Xiaowu Deng, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, China
Yimei Liu, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, China
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