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Radiotherapy Plan Quality Assurance in the ABC-07 Trial of Stereotactic Body Radiotherapy for Locally Advanced
D J Eaton1, D H Brand2, N Hava3
1Department of Medical Physics and Clinical Engineering, Guy's and St Thomas' Hospitals, London, United Kingdom; School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom.
Clinical Oncology (Royal College of Radiologists (Great Britain))
|January 9, 2026
Summary
Radiotherapy quality assurance for biliary tract cancers (BTCs) showed initial variability in segmentation and plan coverage, but improved during the trial. Target coverage was often compromised to protect organs at risk.
Area of Science:
- Radiation Oncology
- Medical Physics
- Clinical Trial Quality Assurance
Background:
- Locally advanced biliary tract cancers (BTCs) pose treatment challenges.
- The ABC-07 trial investigated stereotactic body radiotherapy (SBRT) combined with chemotherapy for BTCs.
- Radiotherapy quality assurance (RTQA) is crucial for SBRT trial integrity.
Purpose of the Study:
- To report the RTQA findings for SBRT treatment plans in the ABC-07 phase II trial.
- To assess the accuracy of segmentation and quality of SBRT plans.
- To evaluate adherence to protocol objectives and organ-at-risk (OAR) constraints.
Main Methods:
- RTQA included pre-trial benchmark contouring and planning cases.
- Prospective independent case review (ICR) of early SBRT cases was performed.
- Plans were evaluated for target coverage (e.g., D95%) and OAR constraints.
Main Results:
- Initial benchmark submissions required revisions (35% contouring, 35% planning).
- Prospective ICR identified revisions in 26% of cases.
- 46% of plans had deviations, often due to target coverage compromise (D95% < 90%) to spare organs like the duodenum and stomach.
Conclusions:
- Rigorous RTQA identified variability in segmentation and plan coverage.
- Revision rates decreased from pre-trial to on-trial cases.
- Compromises in target coverage were frequently necessary to meet OAR constraints, highlighting the need for prespecification in future studies.
