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Corrigan KL, Kry S, Howell RM, Kouzy R, Jaoude JA, Patel RR, Jhingran A, Taniguchi C, Koong AC, McAleer MF, Nitsch P, Rödel C, Fokas E, Minsky BD, Das P, Fuller CD, Ludmir EB. The radiotherapy quality assurance gap among phase III cancer clinical trials. Radiother Oncol 2022; 166:51-57. [PMID: 34838891 PMCID: PMC8900671 DOI: 10.1016/j.radonc.2021.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Quality assurance (QA) practices improve the quality level of oncology trials by ensuring that the protocol is followed and the results are valid and reproducible. This study investigated the utilization of QA among randomized controlled trials that involve radiotherapy (RT). METHODS AND MATERIALS We searched ClinicalTrials.gov in February 2020 for all phase III oncology randomized clinical trials (RCTs). These trials were screened for RT-specific RCTs that had published primary trial results. Information regarding QA in each trial was collected from the study publications and trial protocol if available. Two individuals independently performed trial screening and data collection. Pearson's Chi-square tests analyses were used to assess factors that were associated with QA inclusion in RT trials. RESULTS Forty-two RCTs with RT as the primary intervention or as a mandatory component of the protocol were analyzed; the earliest was started in 1994 and one trial was still active though not recruiting. Twenty-nine (69%) trials mandated RT quality assurance (RTQA) practices as part of the trial protocol, with 19 (45%) trials requiring institutional credentialing. Twenty-one (50%) trials published protocol deviation outcomes. Clinical trials involving advanced radiation techniques (IMRT, VMAT, SRS, SBRT) did not include more RTQA than trials without these advanced techniques (73% vs. 65%, p = 0.55). Trials that reported protocol deviation outcomes were associated with mandating RTQA in their protocols as compared to trials that did not report these outcomes (100% vs. 38%, p < 0.001). CONCLUSIONS There is a lack of RTQA utilization and transparency in RT clinical trials. It is imperative for RT trials to include increased QA for safe, consistent, and high-quality RT planning and delivery.
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Affiliation(s)
- Kelsey L. Corrigan
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030,
| | - Stephen Kry
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030
| | - Rebecca M. Howell
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030
| | - Ramez Kouzy
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030
| | - Joseph Abi Jaoude
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030
| | - Roshal R. Patel
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030
| | - Anuja Jhingran
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030
| | - Cullen Taniguchi
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030
| | - Albert C. Koong
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030
| | - Mary Fran McAleer
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030
| | - Paige Nitsch
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030
| | - Claus Rödel
- University of Frankfurt, 60323 Frankfurt am Main, Frankfurt, Germany,German Cancer Research Center, 69120 Im Neuenheimer Feld 280, Heidelberg, Germany,German Cancer Consortium, 60590 Frankfurt am Main, Frankfurt, Germany,Frankfurt Cancer Institute, 60596 Frankfurt am Main, Frankfurt, Germany
| | - Emmanouil Fokas
- University of Frankfurt, 60323 Frankfurt am Main, Frankfurt, Germany,German Cancer Research Center, 69120 Im Neuenheimer Feld 280, Heidelberg, Germany,German Cancer Consortium, 60590 Frankfurt am Main, Frankfurt, Germany,Frankfurt Cancer Institute, 60596 Frankfurt am Main, Frankfurt, Germany
| | - Bruce D. Minsky
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030
| | - Prajnan Das
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030
| | - C. David Fuller
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030
| | - Ethan B. Ludmir
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030,Corresponding Author: Ethan B. Ludmir, M.D., 1400 Pressler St., Unit 1422, Houston TX, USA 77030, Phone: 832-729-0998,
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Tan TH, Chen D, Soon YY, Chee Seong Tey J. Quality of reporting of cranial irradiation techniques in randomized controlled trials of primary brain tumors: A systematic review. PLoS One 2020; 15:e0241566. [PMID: 33152747 PMCID: PMC7644083 DOI: 10.1371/journal.pone.0241566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 10/18/2020] [Indexed: 12/02/2022] Open
Abstract
Background To assess the quality of reporting of cranial irradiation (CR) techniques in randomized controlled trials (RCTs) of primary brain tumors. Methods We searched PubMed and EMBASE for RCTs of primary brain tumors, published from January 1999 to November 2019 which included CR as one of the intervention arms. We assessed the initial RCTs report on whether they reported the prespecified ten criteria for CR technique adequately. Multivariable logistic regression was performed to determine the factors that were predictive of adequate quality of reporting. Results We found 85 eligible trial reports. There was significant variability in the quality of reporting among the included studies. Total radiotherapy (RT) dose and fractionation schedule were reported adequately in more than 90% of the included trials. The organs at risk dose constraints, treatment verification procedures and presence or absence of deviations in RT treatment planning and delivery were reported adequately in less than 30% of included trials. Twenty-three trials (27%) reported seven criteria or more adequately. Multivariable analysis showed that trials conducted by cooperative groups, published RT quality assurance results and having a low risk of bias in the methodological quality have higher odds of having adequate quality in reporting of CR technique (judged as adequate reporting in seven criteria or more). Conclusions The quality of reporting on CR techniques in the RCTs of primary brain tumors is variable and suboptimal. Guidelines should be introduced to improve clarity and ensure consistency in the quality of reporting.
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Affiliation(s)
- Teng Hwee Tan
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
- National University Hospital, Singapore, Singapore
- National University Health System, Singapore, Singapore
- National University of Singapore, Singapore, Singapore
| | - Desiree Chen
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
- National University Hospital, Singapore, Singapore
- National University Health System, Singapore, Singapore
- National University of Singapore, Singapore, Singapore
| | - Yu Yang Soon
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
- National University Hospital, Singapore, Singapore
- National University Health System, Singapore, Singapore
- National University of Singapore, Singapore, Singapore
- * E-mail:
| | - Jeremy Chee Seong Tey
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
- National University Hospital, Singapore, Singapore
- National University Health System, Singapore, Singapore
- National University of Singapore, Singapore, Singapore
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Soon YY, Chen D, Tan TH, Seong Tey JC. Quality of reporting on thoracic radiotherapy technique in prospective lung cancer trials: A systematic review. Medicine (Baltimore) 2019; 98:e16124. [PMID: 31261531 PMCID: PMC6617283 DOI: 10.1097/md.0000000000016124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of this study is to assess the quality of reporting of thoracic (T) RT technique for curative intent treatment in prospective lung cancer trials. METHODS We searched MEDLINE for eligible trials published from 1996 to 2016. We assessed the included trials' reports on whether they reported the RT dose prescription method; RT dose-planning procedures; algorithm for tissue inhomogeneity dose corrections; organs at risk dose constraints; target volume definition, simulation and/or motion management procedures; treatment verification procedures; total RT dose; fractionation schedule; conduct of quality assurance as well as presence or absence of deviations in RT treatment planning and delivery adequately. We performed univariable and multivariable logistic regression to determine the factors that may influence the quality of reporting. RESULTS We found 85 eligible trial reports. Target volume definition, total RT dose, and fractionation schedules were reported adequately in more than 90% of the included trials. Algorithm for tissue inhomogeneity dose corrections, simulation and verification procedures, presence or absence of deviations in RT treatment planning and delivery were reported adequately in less than 20% of the included trials. Twenty-three trials (27%) reported 7 criteria or more adequately. Both univariable and multivariable logistic regression showed that trials with RT focused research question were more likely to have adequate quality in reporting (judged as adequate reporting in 7 criteria or more) than trials with non-RT focused question (odds ratio 4.11, 95% confidence interval 1.10 to 15.43, P value = .04). CONCLUSION There is significant variability in the quality of reporting on thoracic radiotherapy treatment in prospective lung cancer trials. Future research should focus on developing consensus guidelines to standardize the reporting of radiotherapy technique in clinical trials.
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Soon YY, Chen D, Tan TH, Tey J. Quality of radiotherapy reporting in randomized controlled trials of prostate cancer. Radiat Oncol 2018; 13:108. [PMID: 29880015 PMCID: PMC5992848 DOI: 10.1186/s13014-018-1053-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 05/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Good radiotherapy reporting in clinical trials of prostate radiotherapy is important because it will allow accurate reproducibility of radiotherapy treatment and minimize treatment variations that can affect patient outcomes. The aim of our study is to assess the quality of prostate radiotherapy (RT) treatment reporting in randomized controlled trials in prostate cancer. METHODS We searched MEDLINE for randomized trials of prostate cancer, published from 1996 to 2016 and included prostate RT as one of the intervention arms. We assessed if the investigators reported the ten criteria adequately in the trial reports: RT dose prescription method; RT dose-planning procedures; organs at risk (OAR) dose constraints; target volume definition, simulation procedures; treatment verification procedures; total RT dose; fractionation schedule; conduct of quality assurance (QA) as well as presence or absence of deviations in RT treatment planning and delivery. We performed multivariate logistic regression to determine the factors that may influence the quality of reporting. RESULTS We found 59 eligible trials. There was significant variability in the quality of reporting. Target volume definition, total RT dose and fractionation schedule were reported adequately in 97% of included trials. OAR constraints, simulation procedures and presence or absence of deviations in RT treatment planning and delivery were reported adequately in 30% of included trials. Twenty-four trials (40%) reported seven criteria or more adequately. Multivariable logistic analysis showed that trials that published their quality assurance results and cooperative group trials were more likely to have adequate quality in reporting in at least seven criteria. CONCLUSION There is significant variability in the quality of reporting on prostate radiotherapy treatment in randomized trials of prostate cancer. We need to have consensus guidelines to standardize the reporting of radiotherapy treatment in randomized trials.
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Affiliation(s)
- Yu Yang Soon
- Department of Radiation Oncology, National Cancer Institue of Singapore, National University Hospital, 5 Lower Kent Road, Singapore, 119074, Singapore
| | - Desiree Chen
- Department of Radiation Oncology, National Cancer Institue of Singapore, National University Hospital, 5 Lower Kent Road, Singapore, 119074, Singapore
| | - Teng Hwee Tan
- Department of Radiation Oncology, National Cancer Institue of Singapore, National University Hospital, 5 Lower Kent Road, Singapore, 119074, Singapore
| | - Jeremy Tey
- Department of Radiation Oncology, National Cancer Institue of Singapore, National University Hospital, 5 Lower Kent Road, Singapore, 119074, Singapore.
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Abrunhosa-Branquinho AN, Bar-Deroma R, Collette S, Clementel E, Liu Y, Hurkmans CW, Feuvret L, Van Beek K, van den Bent M, Baumert BG, Weber DC. Radiotherapy quality assurance for the RTOG 0834/EORTC 26053-22054/NCIC CTG CEC.1/CATNON intergroup trial "concurrent and adjuvant temozolomide chemotherapy in newly diagnosed non-1p/19q deleted anaplastic glioma": Individual case review analysis. Radiother Oncol 2018; 127:292-298. [PMID: 29606522 PMCID: PMC6258055 DOI: 10.1016/j.radonc.2018.03.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/10/2018] [Accepted: 03/13/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND The EORTC phase III 26053-22054/ RTOG 0834/NCIC CTG CEC.1/CATNON intergroup trial was designed to evaluate the impact on concurrent and adjuvant temozolomide chemotherapy in newly diagnosed non-1p/19q deleted anaplastic gliomas. The primary endpoint was overall survival. We report the results of retrospective individual case reviews (ICRs) for the first patient randomized per institution to detect the compliance with the study protocol. MATERIAL AND METHODS Sixty-nine institutions were required to submit the radiotherapy plan of their first randomized patient. Full digital datasets uploaded to the EORTC server were assessed by three independent and blinded reviewers through the EORTC radiotherapy quality assurance platform. RESULTS Sixty-two (90%) of sixty-nine ICRs were received and assessable. Of the 62 cases, 22 were evaluated as per protocol (35.5%), 11 as acceptable variation (17.7%) and 29 were classified as unacceptable variations (46.8%). Most common unacceptable variations were related to the PTV dose (n = 19, 31%) and delineation (n = 17, 27%) processes. CONCLUSIONS The ICR analysis showed a significant number of unacceptable variations with potential impact on tumor control and/or toxicity profile. Prospective ICRs are encouraged for future studies to prevent and correct protocol violations before start of treatment.
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Affiliation(s)
- André N Abrunhosa-Branquinho
- EORTC HQ, Brussels, Belgium; Radiotherapy Department, Hospital de Santa Maria - Centro Hospitalar Lisboa Norte, EPE, Portugal.
| | | | | | | | | | - Coen W Hurkmans
- ROG RTQA Strategic Committee, EORTC, Brussels, Belgium; Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - Loïc Feuvret
- Service de Radiothérapie, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Karen Van Beek
- Department of Radiation Oncology, University Hospital Leuven, Belgium
| | | | - Brigitta G Baumert
- Maastricht University Medical Centre and GROW (School for Oncology and Developmental Biology), Maastricht, Netherlands; Dept. of Radiation Oncology, Paracelsus Clinic, Osnabrück & Dept. of Radiation Oncology, University of Müenster, Germany
| | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland; University Hospital of Zürich, Switzerland
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Tseng M, Tan TH, Zheng H, Soon YY, Tey J. Quality of head and neck radiotherapy reporting in randomized controlled trials. Head Neck 2018; 40:1854-1860. [PMID: 29575476 DOI: 10.1002/hed.25133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 11/29/2017] [Accepted: 02/01/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The purpose of this clinical review was to determine the quality reporting of radiotherapy (RT) in randomized controlled trials (RCTs) of head and neck cancer and its impact on reporting of the trial primary efficacy and toxicity outcomes. METHODS We searched MEDLINE for eligible RCTs published between 1994 and 2015. We assessed the quality of RT reporting and bias in the reporting of trial outcomes using published criteria. RESULTS We found 67 eligible trial reports. There was significant variability in the quality of RT treatment reporting among the included trials. Thirty-two trials had adequate quality RT reporting. Cooperative group trials were more likely to have adequate quality reporting (odds ratio [OR] 3.02; 95% confidence interval [CI] 1.04-9.85). The quality of RT reporting did not influence the bias in the reporting of trial outcomes. CONCLUSION The quality of head and neck RT reporting in RCTs is variable and did not impact on bias in reporting of trial outcomes.
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Affiliation(s)
- Michelle Tseng
- Department of Radiation Oncology, National University Cancer Institute Singapore (NCIS), National University Health Systems (NUHS), Singapore
| | - Teng Hwee Tan
- Department of Radiation Oncology, National University Cancer Institute Singapore (NCIS), National University Health Systems (NUHS), Singapore
| | | | - Yu Yang Soon
- Department of Radiation Oncology, National University Cancer Institute Singapore (NCIS), National University Health Systems (NUHS), Singapore
| | - Jeremy Tey
- Department of Radiation Oncology, National University Cancer Institute Singapore (NCIS), National University Health Systems (NUHS), Singapore
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Rivoirard R, Bourmaud A, Oriol M, Tinquaut F, Méry B, Langrand-Escure J, Vallard A, Fournel P, Magné N, Chauvin F. Quality of reporting in oncology studies: A systematic analysis of literature reviews and prospects. Crit Rev Oncol Hematol 2017; 112:179-189. [DOI: 10.1016/j.critrevonc.2017.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 01/19/2017] [Accepted: 02/14/2017] [Indexed: 12/30/2022] Open
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Abdul Rahim MR, James ML, Hickey BE. Intervention quality is not routinely assessed in Cochrane systematic reviews of radiation therapy interventions. J Med Imaging Radiat Oncol 2017; 61:662-665. [PMID: 28102003 DOI: 10.1111/1754-9485.12589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/17/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The aim of this study was to maximise the benefits from clinical trials involving technological interventions such as radiation therapy. High compliance to the quality assurance protocols is crucial. We assessed whether the quality of radiation therapy intervention was evaluated in Cochrane systematic reviews. METHODS We searched 416 published Cochrane systematic reviews and identified 67 Cochrane systematic reviews that investigated radiation therapy or radiotherapy as an intervention. For each systematic review, either quality assurance or quality control for the intervention was identified by a description of such processes in the published systematic reviews. RESULTS Of the 67 Cochrane systematic reviews studied, only two mentioned quality assurance or quality control. CONCLUSIONS Our findings revealed that 65 of 67 (97%) Cochrane systematic reviews of radiation therapy interventions failed to consider the quality of the intervention. We suggest that advice about the evaluation of intervention quality be added to author support materials.
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Affiliation(s)
- Mohamad R Abdul Rahim
- Christchurch Regional Cancer and Blood Service, Canterbury District Health Board, Christchurch, New Zealand
| | - Melissa L James
- Christchurch Regional Cancer and Blood Service, Canterbury District Health Board, Christchurch, New Zealand
| | - Brigid E Hickey
- Radiation Oncology Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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Thaker NG, Sturdevant L, Jhingran A, Das P, Delclos ME, Gunn GB, McAleer MF, Tereffe W, Choi SL, Frank SJ, Simeone WJ, Martinez W, Hahn SM, Famiglietti R, Kuban DA. Assessing the Quality of a Radiation Oncology Case-Based, Peer-Review Program in an Integrated Academic and Community Cancer Center Network. J Oncol Pract 2016; 12:e476-86. [DOI: 10.1200/jop.2015.005983] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose: Academic centers increasingly find a need to define a comprehensive peer-review program that can translate high-quality radiation therapy (RT) to community network sites. In this study, we describe the initial results of a quarterly quality audit program that aims to improve RT peer-review and provider educational processes across community sites. Materials and Methods: An electronic tool was used by community-based certified member (CM) sites to enter clinical treatment information about patients undergoing peer review. At least 10% of the patient load for each CM physician was selected for audit on a quarterly basis by expert academic faculty. Quality metrics included the review of the management plan, technical plan, and other indicators. RT was scored as being concordant or nonconcordant with institutional guidelines, national standards, or expert judgment. Results: A total of 719 patients were entered into the peer-review database by the first four CM sites. Of 14% of patients audited, 17% (18 of 104) were deemed nonconcordant. Nonconcordance rates were lowest in prevalent disease sites, such as breast (16%), colorectal (14%), and lung (12%), whereas rates were highest in lymphoma (50%), brain (44%), and gynecology (27%). Deficiencies included incomplete staging work-up, incorrect target and normal tissue delineation, and nonadherence to accepted dose-volume constraints. Conclusion: Given the high rate of nonconcordance, we recommend prospective, pre-RT peer review of all patients, and, in particular, expert review of patients that are from low-volume or complex disease sites. An integrated approach to peer review holds a promise of improving the quality, safety, and value of cancer therapy in the community setting.
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Affiliation(s)
| | | | - Anuja Jhingran
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Prajnan Das
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marc E. Delclos
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gary B. Gunn
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Welela Tereffe
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Steven J. Frank
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Wendi Martinez
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stephen M. Hahn
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Gong YUT, Yu J, Pang D, Zhen H, Galvin J, Xiao Y. Automated Extraction of Dose/Volume Statistics for Radiotherapy-Treatment-Plan Evaluation in Clinical-Trial Quality Assurance. Front Oncol 2016; 6:47. [PMID: 26973814 PMCID: PMC4776636 DOI: 10.3389/fonc.2016.00047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 02/16/2016] [Indexed: 12/25/2022] Open
Abstract
Radiotherapy clinical-trial quality assurance is a crucial yet challenging process. This note presents a tool that automatically extracts dose/volume statistics for determining dosimetry compliance review with improved efficiency and accuracy. A major objective of this study is to develop an automated solution for clinical-trial radiotherapy dosimetry review.
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Affiliation(s)
| | - Jialu Yu
- IROC, Philadelphia, PA, USA; Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Dalong Pang
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Heming Zhen
- Rush University Medical Center , Chicago, IL , USA
| | | | - Ying Xiao
- IROC, Philadelphia, PA, USA; Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
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Pain management in the neonatal piglet during routine management procedures. Part 1: a systematic review of randomized and non-randomized intervention studies. Anim Health Res Rev 2015; 15:14-38. [PMID: 25605277 DOI: 10.1017/s1466252314000061] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Routine procedures carried out on piglets (i.e. castration, tail docking, teeth clipping, and ear notching) are considered painful. Unfortunately the efficacy of current pain mitigation modalities is poorly understood. The aim of this systematic review was to synthesize the existing primary scientific literature regarding the effectiveness of pain management interventions used for routine procedures on piglets. The review question was, 'In piglets under twenty-eight days old, undergoing castration, tail docking, teeth clipping, and/or methods of identification that involve cutting of the ear tissue, what is the effect of pain mitigation compared with no pain mitigation on behavioral and non-behavioral outcomes that indicate procedural pain and post-procedural pain?' A review protocol was designed a priori. Data sources used were Agricola (EBSCO), CAB Abstracts (Thomson Reuters), PubMed, Web of Science (Thomson Reuters), BIOSIS Previews (Thomson Reuters), and ProQuest Dissertations & Theses Full Text. No restrictions on year of publication or language were placed on the search. Eligible studies assessed an intervention designed to mitigate the pain of the procedures of interest and included a comparison group that did not receive an intervention. Eligible non-English studies were translated using a translation service. Two reviewers independently screened titles and abstracts for relevance using pre-defined questions. Data were extracted from relevant articles onto pre-defined forms. From the 2203 retrieved citations forty publications, containing 52 studies met the eligibility criteria. In 40 studies, piglets underwent castration only. In seven studies, piglets underwent tail docking only. In one study, piglets underwent teeth clipping only, and in one study piglets underwent ear notching only. Three studies used multiple procedures. Thirty-two trial arms assessed general anesthesia protocols, 30 trial arms assessed local anesthetic protocols, and 28 trial arms assessed non-steroidal anti-inflammatory drugs (NSAIDs) protocols. Forty-one trial arms were controls where piglets received either placebo or no treatment. Forty-five outcomes were extracted from the studies, however only the results from studies that assessed cortisol (six studies), β-endorphins (one study), vocalisations (nine studies), and pain-related behaviors (nine studies) are reported. Other outcomes were reported in only one or two studies. Confident decision making will likely be difficult based on this body of work because lack of comprehensive reporting precludes calculation of the magnitude of pain mitigation for most outcomes.
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Altwairgi AK, Alfakeeh AH, Hopman WM, Parulekar WR. Quality of reporting of chemotherapy compliance in randomized controlled trials of breast cancer treatment. Jpn J Clin Oncol 2015; 45:520-6. [DOI: 10.1093/jjco/hyv043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 03/08/2015] [Indexed: 11/14/2022] Open
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Goodman KA. Quality assurance for radiotherapy: a priority for clinical trials. J Natl Cancer Inst 2013; 105:376-7. [PMID: 23468459 DOI: 10.1093/jnci/djt031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lawrence YR, Vikram B, Dignam JJ, Chakravarti A, Machtay M, Freidlin B, Takebe N, Curran WJ, Bentzen SM, Okunieff P, Coleman CN, Dicker AP. NCI-RTOG translational program strategic guidelines for the early-stage development of radiosensitizers. J Natl Cancer Inst 2013; 105:11-24. [PMID: 23231975 PMCID: PMC3536642 DOI: 10.1093/jnci/djs472] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 09/15/2012] [Accepted: 10/02/2012] [Indexed: 12/21/2022] Open
Abstract
The addition of chemotherapeutic agents to ionizing radiation has improved survival in many malignancies. Cure rates may be further improved by adding novel targeted agents to current radiotherapy or radiochemotherapy regimens. Despite promising laboratory data, progress in the clinical development of new drugs with radiation has been limited. To define and address the problems involved, a collaborative effort between individuals within the translational research program of the Radiation Oncology Therapy Group and the National Cancer Institute was established. We discerned challenges to drug development with radiation including: 1) the limited relevance of preclinical work, 2) the pharmaceutical industry's diminished interest, and 3) the important individual skills and institutional commitments required to ensure a successful program. The differences between early-phase trial designs with and without radiation are noted as substantial. The traditional endpoints for early-phase clinical trials-acute toxicity and maximum-tolerated dose-are of limited value when combining targeted agents with radiation. Furthermore, response rate is not a useful surrogate marker of activity in radiation combination trials.Consequently, a risk-stratified model for drug-dose escalation with radiation is proposed, based upon the known and estimated adverse effects. The guidelines discuss new clinical trial designs, such as the time-to-event continual reassessment method design for phase I trials, randomized phase II "screening" trials, and the use of surrogate endpoints, such as pathological response. It is hoped that by providing a clear pathway, this article will accelerate the rate of drug development with radiation.
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Current and future management of NK/T-cell lymphoma based on clinical trials. Int J Hematol 2012; 96:562-71. [DOI: 10.1007/s12185-012-1189-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 09/22/2012] [Accepted: 09/24/2012] [Indexed: 11/26/2022]
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Albert JM, Das P. Quality indicators in radiation oncology. Int J Radiat Oncol Biol Phys 2012; 85:904-11. [PMID: 23040217 DOI: 10.1016/j.ijrobp.2012.08.038] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 08/28/2012] [Accepted: 08/29/2012] [Indexed: 11/28/2022]
Abstract
Oncologic specialty societies and multidisciplinary collaborative groups have dedicated considerable effort to developing evidence-based quality indicators (QIs) to facilitate quality improvement, accreditation, benchmarking, reimbursement, maintenance of certification, and regulatory reporting. In particular, the field of radiation oncology has a long history of organized quality assessment efforts and continues to work toward developing consensus quality standards in the face of continually evolving technologies and standards of care. This report provides a comprehensive review of the current state of quality assessment in radiation oncology. Specifically, this report highlights implications of the healthcare quality movement for radiation oncology and reviews existing efforts to define and measure quality in the field, with focus on dimensions of quality specific to radiation oncology within the "big picture" of oncologic quality assessment efforts.
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Affiliation(s)
- Jeffrey M Albert
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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FitzGerald TJ. What we have learned: the impact of quality from a clinical trials perspective. Semin Radiat Oncol 2012; 22:18-28. [PMID: 22177875 DOI: 10.1016/j.semradonc.2011.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
In this review article, we address the radiation oncology process improvements in clinical trials and review how these changes improve the quality for the next generation of trials. In recent years, we have progressed from a time of limited data acquisition to the present in which we have real-time influence of clinical trials quality. This enables immediate availability of the important elements, including staging, eligibility, response, and outcome for all trial investigators. Modern informatics platforms are well designed for future adaptive clinical trials. We review what will be needed in the informatics architecture of current and future clinical trials.
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Affiliation(s)
- Thomas J FitzGerald
- Department of Radiation Oncology, UMass Memorial Healthcare, University of Massachusetts Medical School, Worcester, MA, USA.
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Cella L, Liuzzi R, Magliulo M, Conson M, Camera L, Salvatore M, Pacelli R. Radiotherapy of large target volumes in Hodgkin's lymphoma: normal tissue sparing capability of forward IMRT versus conventional techniques. Radiat Oncol 2010; 5:33. [PMID: 20459790 PMCID: PMC2881006 DOI: 10.1186/1748-717x-5-33] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 05/11/2010] [Indexed: 11/29/2022] Open
Abstract
Background This paper analyses normal tissue sparing capability of radiation treatment techniques in Hodgkin's lymphoma with large treatment volume. Methods 10 patients with supradiaphragmatic Hodgkin's lymphoma and planning target volume (PTV) larger than 900 cm3 were evaluated. Two plans were simulated for each patient using 6 MV X-rays: a conventional multi-leaf (MLC) parallel-opposed (AP-PA) plan, and the same plan with additional MLC shaped segments (forward planned intensity modulated radiation therapy, FPIMRT). In order to compare plans, dose-volume histograms (DVHs) of PTV, lungs, heart, spinal cord, breast, and thyroid were analyzed. The Inhomogeneity Coefficient (IC), the PTV receiving 95% of the prescription dose (V95), the normal tissue complication probability (NTCP) and dose-volume parameters for the OARs were determined. Results the PTV coverage was improved (mean V95AP-PA = 95.9 and ICAP-PA = 0.4 vs. V95FPIMRT = 96.8 and ICFPIMRT = 0.31, p ≤ 0.05) by the FPIMRT technique compared to the conventional one. At the same time, NTCPs of lung, spinal cord and thyroid, and the volume of lung and thyroid receiving ≥ 30 Gy resulted significantly reduced when using the FPIMRT technique. Conclusions The FPIMRT technique can represent a very useful and, at the same time, simple method for improving PTV conformity while saving critical organs when large fields are needed as in Hodgkin's lymphoma.
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Affiliation(s)
- Laura Cella
- Institute of Biostructures and Bioimages, National Council of Research (CNR), Via Pansini 5, 80131, Naples, Italy
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Fitzgerald TJ, Bishop-Jodoin M, Cicchetti MG, Hanusik R, Kessel S, Laurie F, McCarten KM, Moni J, Pieters RS, Rosen N, Ulin K, Urie M, Chauvenet AR, Constine LS, Deye J, Vikram B, Friedman D, Marcus RB, Mendenhall NP, Williams JL, Purdy J, Saltz J, Schwartz CL, White KS, Wolden S. Quality of radiotherapy reporting in randomized controlled trials of Hodgkin's lymphoma and non-Hodgkin's lymphoma: in regard to Bekelman and Yahalom (Int J Radiat Oncol Biol Phys 2009;73:492-498). Int J Radiat Oncol Biol Phys 2010; 77:315-6. [PMID: 20394859 DOI: 10.1016/j.ijrobp.2009.12.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 12/18/2009] [Indexed: 11/27/2022]
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