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

Andrea C Lo1, Sarah A Milgrom2, Raymond Mailhot Vega3

  • 1Division of Radiation Oncology, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.

International Journal of Radiation Oncology, Biology, Physics
|December 26, 2025
PubMed
Summary

Radiation therapy quality assurance (RTQA) is crucial for lymphoma clinical trials. A rigorous central review process in the COG AHOD2131 trial identified and corrected errors, improving treatment accuracy.

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Area of Science:

  • Radiation Oncology
  • Clinical Trials
  • Medical Physics

Background:

  • Radiation therapy quality assurance (RTQA) is critical in clinical trials involving radiation therapy (RT).
  • Lymphoma RT has advanced to complex techniques like involved-site radiation therapy (ISRT) and PET-directed residual site radiation therapy (pRSRT), increasing target delineation challenges.
  • Suboptimal RT can significantly harm young lymphoma patients, a highly curable population.

Purpose of the Study:

  • To evaluate the effectiveness of real-time central review of PET scans, target volumes, and RT plans in the Children's Oncology Group (COG) trial AHOD2131 for Hodgkin lymphoma (HL).
  • To establish a potential blueprint for RTQA in future lymphoma trials.

Main Methods:

  • Implementation of real-time central review for PET scans, target volumes, and RT plans within the COG AHOD2131 trial.
  • Analysis of early trial experience to identify common errors and deviations from protocol.

Main Results:

  • The rigorous central review process successfully identified protocol deviations before treatment initiation.
  • Common errors included omission of involved disease sites (potentially due to PET/CT-simulation CT fusion issues) and over-generous target volume contouring.
  • Timely corrections were enabled by the review process.

Conclusions:

  • The central review methodology used in AHOD2131 effectively identifies and facilitates correction of RT errors in lymphoma trials.
  • This approach can serve as a model for RTQA in future lymphoma studies, aiming to enhance treatment accuracy and improve patient outcomes.