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Quality assurance for the EORTC 22071-26071 study: dummy run prospective analysis
Alysa Fairchild1, Johannes A Langendijk2, Sandra Nuyts3
1Department of Radiation Oncology, Cross Cancer Institute, 11560 University Avenue, T6G 1Z2, Edmonton, AB, Canada. alysa@ualberta.ca.
Radiation Oncology (London, England)
|November 27, 2014
Summary
Quality assurance for intensity modulated radiotherapy (IMRT) in head and neck cancer trials is complex. A dummy run revealed significant variations in treatment planning, impacting contour acceptability and dose constraints for organs at risk.
Area of Science:
- Radiation oncology
- Medical physics
- Clinical trial methodology
Background:
- Adjuvant chemotherapy combined with intensity modulated radiotherapy (IMRT) is a standard treatment for locally advanced resected squamous cell head and neck cancer.
- Panitumumab is being evaluated for its potential addition to this treatment regimen in a phase III trial (22071-26071).
- Ensuring protocol adherence and consistent treatment planning across multiple institutions is critical for trial success.
Purpose of the Study:
- To report the findings of a dummy run (DR) conducted for the phase III 22071-26071 trial.
- To identify and quantify deviations from protocol guidelines in treatment planning for head and neck cancer.
- To assess the feasibility of quality assurance procedures for IMRT in a multicenter setting.
Main Methods:
- A dummy run (DR) involved digitally uploading datasets, including target volumes (GTV, CTV, PTV), organs at risk (OAR), and treatment plans.
- Six central reviewers compared uploaded data against reference contours and established protocol guidelines.
- Statistical analyses were performed to evaluate contour acceptability, dose requirement adherence, and correlations between delineation quality and plan characteristics.
Main Results:
- A high percentage of Gross Tumor Volumes (GTVs) were deemed acceptable or borderline (87.0%), but Critical CTVs (56.5%) and Planning PTVs (43.5%) showed lower acceptability.
- While 73.9% of cases met all PTV dose requirements, adherence to mandatory OAR dose constraints varied from 65.2% to 100%.
- Significant correlations were found between subjective contour acceptability and the ability to meet OAR dose constraints (p ≤ 0.01), except for parotids and spinal cord. Ipsilateral parotid doses correlated with CTV and PTV volumes (p ≤ 0.05).
Conclusions:
- The dummy run highlighted substantial variability in treatment planning for IMRT in head and neck cancer studies.
- These variations persist despite the implementation of strict protocol guidelines.
- The findings underscore the inherent complexity in developing and assuring quality for multicenter IMRT studies in this patient population.