Purpose: Radiotherapy is a widely accepted standard of care for early-stage prostate
cancer, and it is believed that the plan quality and treatment outcome are
associated with contour accuracy of both the target and organs-at-risk (OAR).
The purposes of this study are to 1) assess geometric and dosimetric
uncertainties due to inter-observer contour variabilities and 2) evaluate the
effectiveness of geometric indicators to predict target dosimetry in prostate
radiotherapy. Methods: Twenty prostate patients were selected for this
retrospective study. Five experienced clinicians created unique structure sets
containing prostate, seminal vesicles, bladder, and rectum for each patient. A
fully automated script and knowledge-based planning routine were utilized to
create standardized and unbiased plans that could be used to evaluate changes
in isodose distributions due to inter-observer variability in structure
segmentation. Plans were created on a “gold-standard” structure set, as well as
on each of the user-defined structure sets. Results: Inter-observer
variability of contours during structure segmentation was very low for clearly
defined organs such as the bladder but increased for organs without
well-defined borders (prostate, seminal vesicles, and rectum). For plans
generated with the user-defined structure sets, strong/moderate correlations
were observed between the geometric indicators for target structure agreement
and target coverage for both low-risk and intermediate-risk patient groups,
while OAR indicators showed no correlation to final dosimetry. Conclusions: Target delineation is crucial in order to maintain adequate dosimetric coverage
regardless of the associated inter-observer uncertainties in OAR contours that
had a limited impact upon final dosimetry.
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