Enhancing Radiation Therapy Quality Assurance in Lymphoma: A Rigorous Real-Time Central Review Process in AHOD2131

Although radiation therapy quality assurance (RTQA) is important in any clinical trial with a radiation therapy (RT) component, it is paramount in lymphoma trials for several reasons. As lymphoma RT has evolved to use smaller and more complex treatment fields such as involved-site radiation therapy (ISRT) and positron emission tomography (PET)-directed residual-site radiation therapy (pRSRT), accurate target delineation has become more challenging, especially when lymphoma patients comprise only a small proportion of most radiation oncologists' clinical practice. Furthermore, lymphoma is often a highly curable malignancy in young patients, augmenting the detrimental impact of suboptimal RT. The Children's Oncology Group trial AHOD2131 of frontline therapy for Hodgkin lymphoma incorporates real-time central review of PET scans, target volumes, and RT plans. Early experience shows that this rigorous approach identifies protocol deviations and enables timely corrections before treatment begins. Common errors include omitting initially involved disease sites, potentially due to inaccurate fusion of the PET and computed tomography with the simulation computed tomography, and over-generous contouring of target volumes. The AHOD2131 central review methodology may serve as a blueprint for RTQA in future lymphoma trials, improving treatment accuracy and patient outcomes.