Analysis of radiation therapy quality assurance in NRG oncology RTOG 0848 Journal Article
| Authors: | Tchelebi, L. T.; Winter, K. A.; Abrams, R. A.; Safran, H. P.; Regine, W. F.; McNulty, S.; Wu, A.; Du, K. L.; Seaward, S. A.; Bian, S. X.; Aljumaily, R.; Shivnani, A.; Knoble, J. L.; Crocenzi, T. S.; DiPetrillo, T. A.; Roof, K. S.; Crane, C. H.; Goodman, K. A. |
| Article Title: | Analysis of radiation therapy quality assurance in NRG oncology RTOG 0848 |
| Abstract: | Purpose: NRG/Radiation Therapy Oncology Group 0848 is a 2-step randomized trial to evaluate the benefit of the addition of concurrent fluoropyrimidine and radiation therapy (RT) after adjuvant chemotherapy (second step) for patients with resected pancreatic head adenocarcinoma. Real-time quality assurance (QA) was performed on each patient who underwent RT. This analysis aims to evaluate adherence to protocol-specified contouring and treatment planning and to report the types and frequencies of deviations requiring revisions. Methods and Materials: In addition to a web-based contouring atlas, the protocol outlined step-by-step instructions for generating the clinical treatment volume through the creation of specific regions of interest. The planning target volume was a uniform 0.5 cm clinical treatment volume expansion. One of 2 radiation oncology study chairs independently reviewed each plan. Plans with unacceptable deviations were returned for revision and resubmitted until approved. Treatment started after final approval of the RT plan. Results: From 2014 to 2018, 354 patients were enrolled in the second randomization. Of these, 160 patients received RT and were included in the QA analysis. Resubmissions were more common for patients planned with 3-dimensional conformal RT (43%) than with intensity modulated RT (31%). In total, at least 1 resubmission of the treatment plan was required for 33% of patients. Among patients requiring resubmission, most only needed 1 resubmission (87%). The most common reasons for resubmission were unacceptable deviations with respect to the preoperative gross target volume (60.7%) and the pancreaticojejunostomy (47.5%). Conclusion: One-third of patients required resubmission to meet protocol compliance criteria, demonstrating the continued need for expending resources on real-time, pretreatment QA in trials evaluating the use of RT, particularly for pancreas cancer. Rigorous QA is critically important for clinical trials involving RT to ensure that the true effect of RT is assessed. Moreover, RT QA serves as an educational process through providing feedback from specialists to practicing radiation oncologists on best practices. © 2023 Elsevier Inc. |
| Keywords: | controlled study; cancer surgery; major clinical study; intensity modulated radiation therapy; erlotinib; treatment planning; gemcitabine; cancer patient; cancer radiotherapy; chemotherapy; preoperative evaluation; quality control; radiotherapy dosage; radiotherapy; practice guideline; oncology; pancreas carcinoma; radiation oncology; radiotherapy, intensity-modulated; quality assurance; adjuvant chemotherapy; pancreas adenocarcinoma; radiotherapy planning, computer-assisted; radiotherapy, conformal; randomized trial; fluoropyrimidine; radiation therapy oncology groups; chemoradiotherapy; clinical target volume; randomized controlled trial (topic); conformal radiotherapy; phase 2 clinical trial (topic); phase 3 clinical trial (topic); pancreaticojejunostomy; protocol compliance; procedures; oncological parameters; pancreatic carcinoma; contouring; treatment volumes; planning target volume; gross target volume; humans; human; article; radiation oncologist; pancreatic head; fluoropyrimidines; clinical treatments; real-time quality |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 118 |
| Issue: | 1 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2024-01-01 |
| Start Page: | 107 |
| End Page: | 114 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2023.08.014 |
| PUBMED: | 37598723 |
| PROVIDER: | scopus |
| PMCID: | PMC10843017 |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
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