1
|
Plan quality association between dummy run and individual case review in a prospective multi-institutional clinical trial of postoperative cervical cancer patients treated with intensity-modulated radiotherapy: Japan Clinical Oncology Group study (JCOG1402). Radiother Oncol 2023; 183:109630. [PMID: 36934892 DOI: 10.1016/j.radonc.2023.109630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND AND PURPOSE The Japan Clinical Oncology Group (JCOG) 1402 conducted a multicenter clinical trial of postoperative intensity-modulated radiotherapy (IMRT) for high-risk uterine cervical cancer patients. We assess effectiveness of the quality assurance (QA) program in central review through dummy runs (DRs) performed before patient enrollment and post-treatment individual case review (ICR), and clarify the pitfalls in treatment planning. MATERIAL AND METHODS The ICRs were conducted using the same QA program as the DR for 214 plans. The deviations were compared with those demonstrated in the DRs, and the pitfalls were clarified. Fifteen face-to-face meetings were held with physicians at participating institutions to provide feedback. RESULTS Two-hundred and eighty-nine deviations and nine violations were detected in the 214 plans. The patterns of the deviations observed in the ICRs were similar to that in the DR. Frequent deviations were observed in clinical target volume (CTV) delineations, 50% in the DRs and 35% in the ICRs, respectively. In the ICRs, approximately 1.4 deviations/violations were observed per plan, which was lower than DR. Nine violations included inaccurate CTV delineation and improper PTV (planning target volume) margin, which had risks in loco-regional failures by inadequate dose coverage. CONCLUSIONS Our developed QA program commonly used in DR and ICR clarified the pitfalls in treatment plans. Although the frequent deviations in CTV delineations were observed in the ICR, the deviations decreased compared to that in the DR. More specified face-to-face meetings with participating institutions will be necessary to maintain the quality of IMRT in the clinical protocol. TRIAL REGISTRATION Japanese Clinical Trial Registry #: UMIN000027017 at https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000030672;language=J.
Collapse
|
2
|
Hernandez S, Nguyen C, Gay S, Duryea J, Howell R, Fuentes D, Parkes J, Burger H, Cardenas C, Paulino AC, Pollard-Larkin J, Court L. Resection cavity auto-contouring for patients with pediatric medulloblastoma using only CT information. J Appl Clin Med Phys 2023:e13956. [PMID: 36917640 DOI: 10.1002/acm2.13956] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 03/15/2023] Open
Abstract
PURPOSE Target delineation for radiation therapy is a time-consuming and complex task. Autocontouring gross tumor volumes (GTVs) has been shown to increase efficiency. However, there is limited literature on post-operative target delineation, particularly for CT-based studies. To this end, we trained a CT-based autocontouring model to contour the post-operative GTV of pediatric patients with medulloblastoma. METHODS One hundred four retrospective pediatric CT scans were used to train a GTV auto-contouring model. Eighty patients were then preselected for contour visibility, continuity, and location to train an additional model. Each GTV was manually annotated with a visibility score based on the number of slices with a visible GTV (1 = < 25%, 2 = 25-50%, 3 = > 50-75%, and 4 = > 75-100%). Contrast and the contrast-to-noise ratio (CNR) were calculated for the GTV contour with respect to a cropped background image. Both models were tested on the original and pre-selected testing sets. The resulting surface and overlap metrics were calculated comparing the clinical and autocontoured GTVs and the corresponding clinical target volumes (CTVs). RESULTS Eighty patients were pre-selected to have a continuous GTV within the posterior fossa. Of these, 7, 41, 21, and 11 were visibly scored as 4, 3, 2, and 1, respectively. The contrast and CNR removed an additional 11 and 20 patients from the dataset, respectively. The Dice similarity coefficients (DSC) were 0.61 ± 0.29 and 0.67 ± 0.22 on the models without pre-selected training data and 0.55 ± 13.01 and 0.83 ± 0.17 on the models with pre-selected data, respectively. The DSC on the CTV expansions were 0.90 ± 0.13. CONCLUSION We successfully automatically contoured continuous GTVs within the posterior fossa on scans that had contrast > ± 10 HU. CT-Based auto-contouring algorithms have potential to positively impact centers with limited MRI access.
Collapse
Affiliation(s)
- Soleil Hernandez
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Callistus Nguyen
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Skylar Gay
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jack Duryea
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rebecca Howell
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David Fuentes
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA.,Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Jeannette Parkes
- Department of Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Hester Burger
- Department of Medical Physics, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Carlos Cardenas
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Julianne Pollard-Larkin
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Laurence Court
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
3
|
Adherence to contouring and treatment planning requirements within a multicentric trial -results of the quality assurance of the SAKK 09/10 trial. Int J Radiat Oncol Biol Phys 2022; 113:80-91. [PMID: 34990777 DOI: 10.1016/j.ijrobp.2021.12.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the results of the radiation therapy (RT) quality assurance (QA) program of the phase III randomized "XXXX-Anonymized for Review" trial in biochemically recurrent prostate cancer (PC) patients after prostatectomy. METHODS AND MATERIALS Within the "XXXX-Anonymized for Review" trial testing 64Gy versus 70Gy salvage RT, a central collection of treatment plans were performed, which were thoroughly reviewed by a dedicated medical physicist and radiation oncologist. Adherence to the treatment protocol and specifically to the European Organization for the Research and Treatment of Cancer (EORTC) guidelines for target volume definition (classified as deviation observed yes vs. no) and its potential correlation with acute and late toxicity (Common Terminology Criteria for Adverse Events (CTCAE) v4.0) and freedom from biochemical progression (FFBP) were investigated. RESULTS The treatment plans of 344 patients treated between February 2011 and April 2014 depicted important deviations to the EORTC guidelines and to the recommendations per trial protocol. For example, in up to half of the cases, the delineated structures deviated from the protocol (e.g., prostate bed (PB) in 48.8%, rectal wall (RW) in 41%). In addition, variations in clinical (CTV) - and planning target volume (PTV) occurred frequently (e.g., CTV and PTV deviations in up to 42.4% and 25.9%, respectively). The detected deviations showed a significant association with a lower risk of grade ≥ 2 gastrointestinal (GI) acute toxicity when CTV not overlapped RW vs. CTV overlapping RW, (OR 0.43; CI [0.22, 0.85]; p= 0.014), and a higher rate of grade ≥ 2 late genitourinary (GU) toxicity in case of the CTV overlapped with RW, (OR 2.58; CI [1.17, 5.72]; p= 0.019). A marginally significant lower risk of grade ≥ 2 late GU toxicity in patients when PB not overlapping RW versus overlapping RW was observed (OR 0.51; CI [0.25, 1.03]; p= 0.06). In addition, a marginally significant decrease of FFBP in patients with PTV not including surgical clips as potential markers of the limits of the prostate bed, (HR 1.44; CI [0.96, 2.17]; p= 0.07) was observed. CONCLUSIONS Despite a thorough QA program, the central review of a phase-III trial showed limited adherence to treatment protocol recommendations which was associated with a higher risk of toxicity by means of acute or late GI or GU toxicity and showed a trend towards worse FFBP. Data from this QA review may help refine future QA programs and prostate bed delineation guidelines.
Collapse
|
4
|
Bolla M, Neven A, Maingon P, Carrie C, Boladeras A, Andreopoulos D, Engelen A, Sundar S, van der Steen-Banasik EM, Armstrong J, Peignaux-Casasnovas K, Boustani J, Herrera FG, Pieters BR, Slot A, Bahl A, Scrase CD, Azria D, Jansa J, O'Sullivan JM, Van Den Bergh ACM, Collette L. Short Androgen Suppression and Radiation Dose Escalation in Prostate Cancer: 12-Year Results of EORTC Trial 22991 in Patients With Localized Intermediate-Risk Disease. J Clin Oncol 2021; 39:3022-3033. [PMID: 34310202 DOI: 10.1200/jco.21.00855] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The European Organisation for Research and Treatment of Cancer (EORTC) trial 22991 (NCT00021450) showed that 6 months of concomitant and adjuvant androgen suppression (AS) improves event- (EFS, Phoenix) and clinical disease-free survival (DFS) of intermediate- and high-risk localized prostatic carcinoma, treated by external-beam radiotherapy (EBRT) at 70-78 Gy. We report the long-term results in intermediate-risk patients treated with 74 or 78 Gy EBRT, as per current guidelines. PATIENT AND METHODS Of 819 patients randomly assigned between EBRT or EBRT plus AS started on day 1 of EBRT, 481 entered with intermediate risk (International Union Against Cancer TNM 1997 cT1b-c or T2a with prostate-specific antigen (PSA) ≥ 10 ng/mL or Gleason ≤ 7 and PSA ≤ 20 ng/mL, N0M0) and had EBRT planned at 74 (342 patients, 71.1%) or 78 Gy (139 patients, 28.9%). We report the trial primary end point EFS, DFS, distant metastasis-free survival (DMFS), and overall survival (OS) by intention-to-treat stratified by EBRT dose at two-sided α = 5%. RESULTS At a median follow-up of 12.2 years, 92 of 245 patients and 132 of 236 had EFS events in the EBRT plus AS and EBRT arm, respectively, mostly PSA relapse (48.7%) or death (45.1%). EBRT plus AS improved EFS and DFS (hazard ratio [HR] = 0.53; CI, 0.41 to 0.70; P < .001 and HR = 0.67; CI, 0.49 to 0.90; P = .008). At 10 years, DMFS was 79.3% (CI, 73.4 to 84.0) with EBRT plus AS and 72.7% (CI, 66.2 to 78.2) with EBRT (HR = 0.74; CI, 0.53 to 1.02; P = .065). With 140 deaths (EBRT plus AS: 64; EBRT: 76), 10-year OS was 80.0% (CI, 74.1 to 84.7) with EBRT plus AS and 74.3% (CI, 67.8 to 79.7) with EBRT, but not statistically significantly different (HR = 0.74; CI, 0.53 to 1.04; P = .082). CONCLUSION Six months of concomitant and adjuvant AS statistically significantly improves EFS and DFS in intermediate-risk prostatic carcinoma, treated by irradiation at 74 or 78 Gy. The effects on OS and DMFS did not reach statistical significance.
Collapse
Affiliation(s)
- Michel Bolla
- Radiotherapy Department Grenoble, Grenoble Alpes University, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Anouk Neven
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Philippe Maingon
- Sorbonne University, APHP Sorbonne University, La Pitié Salpêtrière, Paris, France
| | | | - Ana Boladeras
- Radiation Oncology Department, Catalan Institute of Oncology-University Hospital Germans Trias I Pujol, Badalona, Barcelona, Catalonia, Spain
| | | | | | - Santhanam Sundar
- Nottingham University Hospitals NHS Trust-City Hospital, Consultant Medical Oncologist, Nottingham, United Kingdom
| | | | - John Armstrong
- Radiation Oncology Department, All Ireland Cooperative Oncology Research Group, St Luke's Hospital, Dublin, Ireland
| | | | - Jihane Boustani
- Radiotherapy Department, University Hospital of Besancon-Jean Minjoz Hospital, Besancon, France
| | - Fernanda G Herrera
- Radiation Oncology and Immuno-Oncology Service, University Hospital of Lausanne, Lausanne, Switzerland
| | - Bradley R Pieters
- Department of Radiation Oncology, Amsterdam University Medical Centers/University of Amsterdam, Amsterdam, the Netherlands
| | - Annerie Slot
- Radiotherapeutisch Instituut Friesland, Leeuwarden, the Netherlands
| | - Amit Bahl
- University Hospitals Bristol National Health Service Foundation Trust-Bristol Haematology and Oncology Centre, Bristol Avon, United Kingdom
| | | | - David Azria
- Institut du Cancer de Montpellier, Université de Montpellier, INSERM U1194, Montpellier, France
| | - Jan Jansa
- Klinika Onkologie a Radioterapie-Fakultni nemocnice Hradec Kralove, Hradec Kralove, Czech Republic
| | - Joe M O'Sullivan
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Ireland
| | - Alphonsus C M Van Den Bergh
- Radiotherapy Department, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Laurence Collette
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | | |
Collapse
|
5
|
Stelmes JJ, Vu E, Grégoire V, Simon C, Clementel E, Kazmierska J, Grant W, Ozsahin M, Tomsej M, Vieillevigne L, Fortpied C, Hurkmans EC, Branquinho A, Andratschke N, Zimmermann F, Weber DC. Quality assurance of radiotherapy in the ongoing EORTC 1420 "Best of" trial for early stage oropharyngeal, supraglottic and hypopharyngeal carcinoma: results of the benchmark case procedure. Radiat Oncol 2021; 16:81. [PMID: 33933118 PMCID: PMC8088557 DOI: 10.1186/s13014-021-01809-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/19/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The current phase III EORTC 1420 Best-of trial (NCT02984410) compares the swallowing function after transoral surgery versus intensity modulated radiotherapy (RT) in patients with early-stage carcinoma of the oropharynx, supraglottis and hypopharynx. We report the analysis of the Benchmark Case (BC) procedures before patient recruitment with special attention to dysphagia/aspiration related structures (DARS). MATERIALS AND METHODS Submitted RT volumes and plans from participating centers were analyzed and compared against the gold-standard expert delineations and dose distributions. Descriptive analysis of protocol deviations was conducted. Mean Sorensen-Dice similarity index (mDSI) and Hausdorff distance (mHD) were applied to evaluate the inter-observer variability (IOV). RESULTS 65% (23/35) of the institutions needed more than one submission to achieve Quality assurance (RTQA) clearance. OAR volume delineations were the cause for rejection in 53% (40/76) of cases. IOV could be improved in 5 out of 12 OARs by more than 10 mm after resubmission (mHD). Despite this, final IOV for critical OARs in delineation remained significant among DARS by choosing an aleatory threshold of 0.7 (mDSI) and 15 mm (mHD). CONCLUSIONS This is to our knowledge the largest BC analysis among Head and neck RTQA programs performed in the framework of a prospective trial. Benchmarking identified non-common OARs and target delineations errors as the main source of deviations and IOV could be reduced in a significant number of cases after this process. Due to the substantial resources involved with benchmarking, future benchmark analyses should assess fully the impact on patients' clinical outcome.
Collapse
Affiliation(s)
- J-J Stelmes
- Radiation Oncology Department, Oncology Institute of Southern Switzerland, Via Athos Gallino 12, 6500, Bellinzona, Switzerland.
| | - E Vu
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | - C Simon
- Lausanne University Hospital, Lausanne, Switzerland
| | | | | | - W Grant
- Gloucestershire Hospitals, NHS Foundation Trust, Gloucester, UK
| | - M Ozsahin
- Lausanne University Hospital, Lausanne, Switzerland
| | - M Tomsej
- Hospital of Charleroi, Charleroi, Belgium
| | | | | | | | - A Branquinho
- Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | | | - F Zimmermann
- University Hospital of Basel, Basel, Switzerland
| | - D-C Weber
- University Hospital of Bern, Bern, Switzerland
- Paul-Scherrer-Institute, Villigen, Switzerland
| |
Collapse
|
6
|
Comparison of Survival Between Hypofractionated and Conventional Radiotherapy in Clinically Localized Prostate Cancer: A Single-Center Retrospective Cohort. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2020. [DOI: 10.5812/ijcm.105762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Prostate cancer (pCa) is the most frequently diagnosed visceral cancer among men. The main role of radical prostatectomy and external-beam radiation therapy (EBRT) in the management of patients with localized pCa has been established. Objectives: This study aims at comparing the clinical outcomes of hypofractionated versus conventional EBRT in the definitive management of patients with localized pCa. Methods: From 2013 to 2019, a consecutive series of patients with localized pCa was treated with conventional (74 Gy at 2 Gy fractions) or hypofractionated (70.2 Gy at 2.7 Gy fractions) radiotherapy schedules, using 3-dimensional conformal radiation therapy (3D-CRT) and intensity-modulated radiation therapy (IMRT), respectively. The impact of the fractionation schedule on biochemical or clinical relapse-free survival (bc-RFS) and overall survival (OS) was assessed. Results: The median follow-up was 42 months (range: 8 - 81 months). Among 170 patients, 81 were treated with conventional and 89 with the hypofractionated schedule. The patient characteristics between groups were comparable. The mean bc-RFS of patients in conventional and hypofractionated groups was 34.9 and 35.4 months, respectively (confidence interval (CI) 95%: 34.5 - 35.7, P = 0.25). Accordingly, the mean OS of patients in conventional and hypofractionated groups was 34.6 and 38.6 months, respectively (CI 95%: 37.3 - 38.6, P = 0.04). The sub-analysis showed that the OS benefit of hypofractionated schedule was limited to intermediate- and high-risk groups with a trend toward significance (CI 95%: 0.02 - 1.46, P = 0.054). Conclusions: Hypofractionation had OS benefit over the conventional schedule for definitive radiotherapy of localized pCa. This benefit was limited to patients with intermediate- and high-risk pCa.
Collapse
|
7
|
Naismith O, Mayles H, Bidmead M, Clark CH, Gulliford S, Hassan S, Khoo V, Roberts K, South C, Hall E, Dearnaley D. Radiotherapy Quality Assurance for the CHHiP Trial: Conventional Versus Hypofractionated High-Dose Intensity-Modulated Radiotherapy in Prostate Cancer. Clin Oncol (R Coll Radiol) 2019; 31:611-620. [PMID: 31201110 DOI: 10.1016/j.clon.2019.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/01/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
Abstract
AIMS The CHHiP trial investigated the use of moderate hypofractionation for the treatment of localised prostate cancer using intensity-modulated radiotherapy (IMRT). A radiotherapy quality assurance programme was developed to assess compliance with treatment protocol and to audit treatment planning and dosimetry of IMRT. This paper considers the outcome and effectiveness of the programme. MATERIALS AND METHODS Quality assurance exercises included a pre-trial process document and planning benchmark cases, prospective case reviews and a dosimetry site visit on-trial and a post-trial feedback questionnaire. RESULTS In total, 41 centres completed the quality assurance programme (37 UK, four international) between 2005 and 2010. Centres used either forward-planned (field-in-field single phase) or inverse-planned IMRT (25 versus 17). For pre-trial quality assurance exercises, 7/41 (17%) centres had minor deviations in their radiotherapy processes; 45/82 (55%) benchmark plans had minor variations and 17/82 (21%) had major variations. One hundred prospective case reviews were completed for 38 centres. Seventy-one per cent required changes to clinical outlining pre-treatment (primarily prostate apex and base, seminal vesicles and penile bulb). Errors in treatment planning were reduced relative to pre-trial quality assurance results (49% minor and 6% major variations). Dosimetry audits were conducted for 32 centres. Ion chamber dose point measurements were within ±2.5% in the planning target volume and ±8% in the rectum. 28/36 films for combined fields passed gamma criterion 3%/3 mm and 11/15 of IMRT fluence film sets passed gamma criterion 4%/4 mm using a 98% tolerance. Post-trial feedback showed that trial participation was beneficial in evolving clinical practice and that the quality assurance programme helped some centres to implement and audit prostate IMRT. CONCLUSION Overall, quality assurance results were satisfactory and the CHHiP quality assurance programme contributed to the success of the trial by auditing radiotherapy treatment planning and protocol compliance. Quality assurance supported the introduction of IMRT in UK centres, giving additional confidence and external review of IMRT where it was a newly adopted technique.
Collapse
Affiliation(s)
- O Naismith
- Royal Marsden NHS Foundation Trust, London, UK.
| | - H Mayles
- Clatterbridge Cancer Centre, Bebington, Wirral, UK
| | - M Bidmead
- Royal Marsden NHS Foundation Trust, London, UK
| | - C H Clark
- Royal Surrey County Hospital, Guildford, UK
| | - S Gulliford
- The Institute of Cancer Research, London, UK
| | - S Hassan
- The Institute of Cancer Research, London, UK
| | - V Khoo
- Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - K Roberts
- Royal Marsden NHS Foundation Trust, London, UK
| | - C South
- Royal Surrey County Hospital, Guildford, UK
| | - E Hall
- The Institute of Cancer Research, London, UK
| | - D Dearnaley
- Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | | |
Collapse
|
8
|
Trade-off between the conflicting planning goals in correlation with patient’s anatomical parameters for intensity-modulated radiotherapy of prostate cancer patients. JOURNAL OF RADIOTHERAPY IN PRACTICE 2019. [DOI: 10.1017/s1460396919000025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractAimTo quantify the relationship between the planning target volume (PTV) dose homogeneity and organs at risk (OARs) sparing in correlation with anatomical parameters in prostate intensity-modulated radiotherapy (IMRT).Materials and methodsNine IMRT plans with various target dose constraints’ priorities were created for 15 prostate cancer patients. Selected PTV and OARs parameters were calculated for the patients. A trade-off was assessed between homogeneity index (HI) and OAR sparing. Several anatomical parameters were evaluated to investigate their effects on the OAR sparing and HI.ResultsInverse exponential relationships were found between the OAR sparing and HI (average R
2 of 0·983 and 0·994 for bladder and rectum, respectively). Decreasing the priority led to more OARs sparing (normal tissue complication probability reduction: 97·6 and 74·5%; mean dose reduction: 16·3 and 11·3% for bladder and rectum, respectively) and worsening of the HI (0·095–0·322) but with no significant effect on tumour control probability. Furthermore, OARs volumes, distances between OARs and PTV and their joint volumes had stronger correlations with OARs’ mean doses.ConclusionEnforcement of target dose constraints was more effective on the improvement of HIs for the patients with initial high HI values at low dose constraints’ priorities. Reducing the priority had more effects on the OARs sparing compared to HI, especially for the patients with high OAR doses in high priority plans. This can be attributed to smaller distances or greater joint volumes between the OARs and PTV.
Collapse
|
9
|
Cloak K, Jameson MG, Paneghel A, Wiltshire K, Kneebone A, Pearse M, Sidhom M, Tang C, Fraser‐Browne C, Holloway LC, Haworth A. Contour variation is a primary source of error when delivering post prostatectomy radiotherapy: Results of the Trans‐Tasman Radiation Oncology Group 08.03 Radiotherapy Adjuvant Versus Early Salvage (RAVES) benchmarking exercise. J Med Imaging Radiat Oncol 2019; 63:390-398. [DOI: 10.1111/1754-9485.12884] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/10/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Kirrily Cloak
- South Western Sydney Clinical School University of NSW Sydney New South Wales Australia
- Cancer Therapy Centre Liverpool Hospital Sydney New South Wales Australia
- Ingham Institute of Applied Medical Research Liverpool Hospital Sydney New South Wales Australia
| | - Michael G Jameson
- South Western Sydney Clinical School University of NSW Sydney New South Wales Australia
- Cancer Therapy Centre Liverpool Hospital Sydney New South Wales Australia
- Ingham Institute of Applied Medical Research Liverpool Hospital Sydney New South Wales Australia
| | | | | | - Andrew Kneebone
- University of Sydney Sydney New South Wales Australia
- Royal North Shore Hospital Sydney New South Wales Australia
| | | | - Mark Sidhom
- South Western Sydney Clinical School University of NSW Sydney New South Wales Australia
- Cancer Therapy Centre Liverpool Hospital Sydney New South Wales Australia
| | - Colin Tang
- Sir Charles Gairdner Hospital Perth Western Australia Australia
| | | | - Lois C Holloway
- South Western Sydney Clinical School University of NSW Sydney New South Wales Australia
- Cancer Therapy Centre Liverpool Hospital Sydney New South Wales Australia
- Ingham Institute of Applied Medical Research Liverpool Hospital Sydney New South Wales Australia
| | | |
Collapse
|
10
|
Importance of training in external beam treatment planning for locally advanced cervix cancer: Report from the EMBRACE II dummy run. Radiother Oncol 2019; 133:149-155. [DOI: 10.1016/j.radonc.2019.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/27/2018] [Accepted: 01/09/2019] [Indexed: 11/20/2022]
|
11
|
Kyroudi A, Petersson K, Ozsahin M, Bourhis J, Bochud F, Moeckli R. Analysis of the treatment plan evaluation process in radiotherapy through eye tracking. Z Med Phys 2018; 28:318-324. [DOI: 10.1016/j.zemedi.2017.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/08/2017] [Accepted: 11/21/2017] [Indexed: 11/25/2022]
|
12
|
Multidisciplinary quality assurance and control in oncological trials: Perspectives from European Organisation for Research and Treatment of Cancer (EORTC). Eur J Cancer 2017; 86:91-100. [PMID: 28964907 DOI: 10.1016/j.ejca.2017.07.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 07/25/2017] [Indexed: 02/06/2023]
Abstract
Quality assurance (QA) programmes are one of the mainstays of clinical research and constitute the pillars on which European Organisation for Research Treatment of Cancer (EORTC) delivers multidisciplinary therapeutic progress. Changing practice treatments require solid evidence-based data, which can only be achieved if integral QA is part of the infrastructure sustaining research projects. Cancer treatment is a multimodality approach, which is often applied either in sequence and/or in combination. Each modality plays a key role in cancer control. The modalities by which QA is applied varies substantially within and across the disciplines. In addition, translational and diagnostic disciplines take an increasing role in the era of precision medicine. Building on the structuring effect of clinical research with fully integrated multidisciplinary QA programmes associated with the solutions addressing the chain of custody for biological material and data integrity as well as compliance ensure at the same time validity of clinical research output but also have a training effect on health care providers, who are more likely to apply such principles as routine. The principles of QA are therefore critical to be embedded in multidisciplinary infrastructure to guarantee therapeutic progress. These principles also provide the basis for the functioning of multidisciplinary tumour board. However, technical, operational and economic challenges which go with the implementation of such programmes require optimal know-how and the coordination of the multiple expertise and such efforts are best achieved through centralised infrastructure.
Collapse
|
13
|
Mavroidis P, Komisopoulos G, Buckey C, Mavroeidi M, Swanson GP, Baltas D, Papanikolaou N, Stathakis S. Radiobiological evaluation of prostate cancer IMRT and conformal-RT plans using different treatment protocols. Phys Med 2017; 40:33-41. [DOI: 10.1016/j.ejmp.2017.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/07/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022] Open
|
14
|
Latorzeff I, Sargos P, Loos G, Supiot S, Guerif S, Carrie C. Delineation of the Prostate Bed: The "Invisible Target" Is Still an Issue? Front Oncol 2017; 7:108. [PMID: 28620579 PMCID: PMC5449739 DOI: 10.3389/fonc.2017.00108] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 05/10/2017] [Indexed: 11/13/2022] Open
Abstract
For pathological high-risk prostate cancer, adjuvant irradiation has shown a survival benefit. Phase III studies have highlighted that half men would face biochemical relapse and would be candidate for radiotherapy at adjuvant or salvage times. Despite at least four published international contouring guidelines from different collaborative groups, discrepancies remain for volumes, delineation, and margins to be considered in order to optimize radiotherapy planning. This article from “Groupe d’Etude des Tumeurs UroGénitales (GETUG)” members will focus on controversies to help clinicians to create best volume delineation for adjuvant or salvage post prostatectomy radiotherapy.
Collapse
Affiliation(s)
- Igor Latorzeff
- Department of Oncology Radiotherapy, Bât Atrium, Clinique Pasteur, Toulouse, France
| | - Paul Sargos
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France
| | - Geneviève Loos
- Department of Radiotherapy, Centre Jean-Perrin, Clermont-Ferrand, France
| | - Stéphane Supiot
- Department of Radiotherapy, Institut de Cancérologie de L'Ouest René Gauducheau, Nantes, France
| | - Stéphane Guerif
- Department of Radiotherapy, CHU de Poitiers, Poitiers, France
| | | |
Collapse
|
15
|
Christiaens M, Collette S, Overgaard J, Gregoire V, Kazmierska J, Castadot P, Giralt J, Grant W, Tomsej M, Bar-Deroma R, Monti AF, Hurkmans CW, Weber DC. Quality assurance of radiotherapy in the ongoing EORTC 1219-DAHANCA-29 trial for HPV/p16 negative squamous cell carcinoma of the head and neck: Results of the benchmark case procedure. Radiother Oncol 2017; 123:424-430. [PMID: 28478912 DOI: 10.1016/j.radonc.2017.04.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 04/17/2017] [Accepted: 04/17/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE The phase III EORTC 1219-DAHANCA 29 intergroup trial evaluates the influence of nimorazole in patients with locally advanced head and neck cancer when treated with accelerated radiotherapy (RT) in combination with chemotherapy. This article describes the results of the RT Benchmark Case (BC) performed before patient inclusion. MATERIALS AND METHODS The participating centers were asked to perform a 2-step BC, consisting of (1) a delineation and (2) a planning exercise according to the protocol guidelines. Submissions were prospectively centrally reviewed and feedback was given to the submitting centers. Sørensen-Dice similarity index (DSI) and the 95th percentile Hausdorff distance (HD) were retrospectively used to evaluate the agreement between the centers and the expert contours. RESULTS Fifty-four submissions (34 delineation and 20 planning exercises) from 19 centers were reviewed. Nine (47%) centers needed to perform the delineation step twice and three (16%) centers 3 times before receiving an approval. An increase in DSI-value and a decrease in HD, in particular for the prophylactic Clinical Target Volume (pCTV), could be found for the resubmitted cases. No unacceptable variations could be found for the planning exercise. CONCLUSIONS These BC-results highlight the need for effective and prospective RTQA in clinical trials. Even with clearly defined protocol guidelines, delineation and not planning remain the main reason for unacceptable protocol variations. The introduction of more objective quantitative analysis methods, such as the HD and DSI, in future trials might strengthen the evaluation by experts.
Collapse
Affiliation(s)
- Melissa Christiaens
- EORTC HQ, Brussels, Belgium; Department of Radiation Oncology, University Hospital Leuven, Belgium.
| | | | - Jens Overgaard
- Department of Radiation Oncology, Aarhus University Hospital, Denmark
| | - Vincent Gregoire
- Department of Radiation Oncology, Université Catholique de Louvain, St-Luc University Hospital, Brussels, Belgium
| | | | | | - Jordi Giralt
- Radiation Oncology, Hospital General Vall D'Hebron, Barcelona, Spain
| | - Warren Grant
- Oncology Centre, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, UK
| | | | | | - Angelo F Monti
- Department of Medical Physics, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Coen Wilhelm Hurkmans
- ROG RTQA Strategic Committee, EORTC, Brussels, Belgium; Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - Damien Charles Weber
- ROG RTQA Strategic Committee, EORTC, Brussels, Belgium; Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland; University of Zürich, Switzerland
| |
Collapse
|
16
|
Bolla M, Maingon P, Carrie C, Villa S, Kitsios P, Poortmans PM, Sundar S, van der Steen-Banasik EM, Armstrong J, Bosset JF, Herrera FG, Pieters B, Slot A, Bahl A, Ben-Yosef R, Boehmer D, Scrase C, Renard L, Shash E, Coens C, van den Bergh AC, Collette L. Short Androgen Suppression and Radiation Dose Escalation for Intermediate- and High-Risk Localized Prostate Cancer: Results of EORTC Trial 22991. J Clin Oncol 2016; 34:1748-56. [DOI: 10.1200/jco.2015.64.8055] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose Up to 30% of patients who undergo radiation for intermediate- or high-risk localized prostate cancer relapse biochemically within 5 years. We assessed if biochemical disease-free survival (DFS) is improved by adding 6 months of androgen suppression (AS; two injections of every-3-months depot of luteinizing hormone–releasing hormone agonist) to primary radiotherapy (RT) for intermediate- or high-risk localized prostate cancer. Patients and Methods A total of 819 patients staged: (1) cT1b-c, with prostate-specific antigen (PSA) ≥ 10 ng/mL or Gleason ≥ 7, or (2) cT2a (International Union Against Cancer TNM 1997), with no involvement of pelvic lymph nodes and no clinical evidence of metastatic spread, with PSA ≤ 50 ng/mL, were centrally randomized 1:1 to either RT or RT plus AS started on day 1 of RT. Centers opted for one dose (70, 74, or 78 Gy). Biochemical DFS, the primary end point, was defined from entry until PSA relapse (Phoenix criteria) and clinical relapse by imaging or death of any cause. The trial had 80% power to detect hazard ratio (HR), 0.714 by intent-to-treat analysis stratified by dose of RT at the two-sided α = 5%. Results The median patient age was 70 years. Among patients, 74.8% were intermediate risk and 24.8% were high risk. In the RT arm, 407 of 409 patients received RT; in the RT plus AS arm, 403 patients received RT plus AS and three patients received RT only. At 7.2 years median follow-up, RT plus AS significantly improved biochemical DFS (HR, 0.52; 95% CI, 0.41 to 0.66; P < .001, with 319 events), as well as clinical progression-free survival (205 events, HR, 0.63; 95% CI, 0.48 to 0.84; P = .001). In exploratory analysis, no statistically significant interaction between treatment effect and dose of RT could be evidenced (heterogeneity P = .79 and P = .66, for biochemical DFS and progression-free survival, respectively). Overall survival data are not mature yet. Conclusion Six months of concomitant and adjuvant AS improves biochemical and clinical DFS of intermediate- and high-risk cT1b-c to cT2a (with no involvement of pelvic lymph nodes and no clinical evidence of metastatic spread) prostatic carcinoma, treated by radiation.
Collapse
Affiliation(s)
- Michel Bolla
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Philippe Maingon
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Christian Carrie
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Salvador Villa
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Petros Kitsios
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Philip M.P. Poortmans
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Santhanam Sundar
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Elzbieta M. van der Steen-Banasik
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - John Armstrong
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Jean-François Bosset
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Fernanda G. Herrera
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Bradley Pieters
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Annerie Slot
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Amit Bahl
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Rahamim Ben-Yosef
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Dirk Boehmer
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Christopher Scrase
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Laurette Renard
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Emad Shash
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Corneel Coens
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Alphonsus C.M. van den Bergh
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Laurence Collette
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| |
Collapse
|
17
|
Kirisits C, Federico M, Nkiwane K, Fidarova E, Jürgenliemk-Schulz I, de Leeuw A, Lindegaard J, Pötter R, Tanderup K. Quality assurance in MR image guided adaptive brachytherapy for cervical cancer: Final results of the EMBRACE study dummy run. Radiother Oncol 2015; 117:548-54. [PMID: 26316396 DOI: 10.1016/j.radonc.2015.08.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 07/22/2015] [Accepted: 08/01/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Upfront quality assurance (QA) is considered essential when starting a multicenter clinical trial in radiotherapy. Despite the long experience gained for external beam radiotherapy (EBRT) trials, there are only limited audit QA methods for brachytherapy (BT) and none include the specific aspects of image guided adaptive brachytherapy (IGABT). METHODS AND MATERIALS EMBRACE is a prospective multicenter trial aiming to assess the impact of (MRI)-based IGABT in locally advanced cervical cancer. An EMBRACE dummy run was designed to identify sources and magnitude of uncertainties and errors considered important for the evaluation of clinical, and dosimetric parameters and their relation to outcome. Contouring, treatment planning and dose reporting was evaluated and scored with a categorical scale of 1-10. Active feedback to centers was provided to improve protocol compliance and reporting. A second dummy run was required in case of major deviations (score <7) for any item. RESULTS Overall 27/30 centers passed the dummy run. 16 centers had to repeat the dummy run in order to clarify major inconsistencies to the protocol. The most pronounced variations were related to contouring for both EBRT and BT. Centers with experience in IGABT (>30 cases) had better performance as compared to centers with limited experience. CONCLUSION The comprehensive dummy run designed for the EMBRACE trial has been a feasible tool for QA in IGABT of cervix cancer. It should be considered for future IGABT trials and could serve as the basis for continuous quality checks for brachytherapy centers.
Collapse
Affiliation(s)
- Christian Kirisits
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria.
| | - Mario Federico
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria; Radiation Oncology Department, HUGC Dr. Negrin, Las Palmas, Spain
| | - Karen Nkiwane
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Elena Fidarova
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | | | - Astrid de Leeuw
- Department of Radiation Oncology, University Medical Centre Utrecht, The Netherlands
| | | | - Richard Pötter
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Kari Tanderup
- Department of Oncology, Aarhus University Hospital, Denmark
| |
Collapse
|
18
|
Jameson MG, Ohanessian L, Batumalai V, Patel V, Holloway LC. Comparison of Oncentra® Brachy IPSA and graphical optimisation techniques: a case study of HDR brachytherapy head and neck and prostate plans. J Med Radiat Sci 2015; 62:168-74. [PMID: 26229683 PMCID: PMC4462990 DOI: 10.1002/jmrs.107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 04/08/2015] [Accepted: 04/08/2015] [Indexed: 11/15/2022] Open
Abstract
There are a number of different dwell positions and time optimisation options available in the Oncentra® Brachy (Elekta Brachytherapy Solutions, Veenendaal, The Netherlands) brachytherapy treatment planning system. The purpose of this case study was to compare graphical (GRO) and inverse planning by simulated annealing (IPSA) optimisation techniques for interstitial head and neck (HN) and prostate plans considering dosimetry, modelled radiobiology outcome and planning time. Four retrospective brachytherapy patients were chosen for this study, two recurrent HN and two prostatic boosts. Manual GRO and IPSA plans were generated for each patient. Plans were compared using dose–volume histograms (DVH) and dose coverage metrics including; conformity index (CI), homogeneity index (HI) and conformity number (CN). Logit and relative seriality models were used to calculate tumour control probability (TCP) and normal tissue complication probability (NTCP). Approximate planning time was also recorded. There was no significant difference between GRO and IPSA in terms of dose metrics with mean CI of 1.30 and 1.57 (P > 0.05) respectively. IPSA achieved an average HN TCP of 0.32 versus 0.12 for GRO while for prostate there was no significant difference. Mean GRO planning times were greater than 75 min while average IPSA planning times were less than 10 min. Planning times for IPSA were greatly reduced compared to GRO and plans were dosimetrically similar. For this reason, IPSA makes for a useful planning tool in HN and prostate brachytherapy.
Collapse
Affiliation(s)
- Michael G Jameson
- Liverpool and Macarthur Cancer Therapy Centres Liverpool, New South Wales, Australia ; Centre for Medical Radiation Physics, University of Wollongong Wollongong, New South Wales, Australia ; Ingham Institute of Applied Medical Research Liverpool, New South Wales, Australia
| | - Lucy Ohanessian
- Liverpool and Macarthur Cancer Therapy Centres Liverpool, New South Wales, Australia
| | - Vikneswary Batumalai
- Liverpool and Macarthur Cancer Therapy Centres Liverpool, New South Wales, Australia ; Ingham Institute of Applied Medical Research Liverpool, New South Wales, Australia ; South Western Sydney Clinical School, School of Medicine University of New South Wales, Australia
| | - Virendra Patel
- Liverpool and Macarthur Cancer Therapy Centres Liverpool, New South Wales, Australia
| | - Lois C Holloway
- Liverpool and Macarthur Cancer Therapy Centres Liverpool, New South Wales, Australia ; Centre for Medical Radiation Physics, University of Wollongong Wollongong, New South Wales, Australia ; Ingham Institute of Applied Medical Research Liverpool, New South Wales, Australia ; South Western Sydney Clinical School, School of Medicine University of New South Wales, Australia ; Institute of Medical Physics, School of Physics, University of Sydney Sydney, New South Wales, Australia
| |
Collapse
|
19
|
Hansen CR, Johansen J, Kristensen CA, Smulders B, Andersen LJ, Samsøe E, Andersen E, Petersen JBB, Overgaard J, Grau C. Quality assurance of radiation therapy for head and neck cancer patients treated in DAHANCA 10 randomized trial. Acta Oncol 2015. [PMID: 26206516 DOI: 10.3109/0284186x.2015.1063780] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Jørgen Johansen
- b Department of Oncology , Odense University Hospital , Denmark
| | - Claus A Kristensen
- c Department of Oncology , Finsen Centre, Copenhagen University Hospital , Denmark
| | - Bob Smulders
- c Department of Oncology , Finsen Centre, Copenhagen University Hospital , Denmark
| | | | - Eva Samsøe
- e Department of Oncology , Division of Radiophysics, University Hospital Herlev , Denmark
| | - Elo Andersen
- f Department of Oncology , University Hospital Herlev , Denmark
| | | | - Jens Overgaard
- h Department of Experimental Clinical Oncology , Aarhus University Hospital , Denmark
| | - Cai Grau
- i Department of Oncology , Aarhus University Hospital , Denmark
| |
Collapse
|
20
|
Ghandour S, Matzinger O, Pachoud M. Volumetric-modulated arc therapy planning using multicriteria optimization for localized prostate cancer. J Appl Clin Med Phys 2015; 16:5410. [PMID: 26103500 PMCID: PMC5690115 DOI: 10.1120/jacmp.v16i3.5410] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/30/2015] [Accepted: 01/23/2015] [Indexed: 11/23/2022] Open
Abstract
The purpose of this work is to evaluate the volumetric‐modulated arc therapy (VMAT) multicriteria optimization (MCO) algorithm clinically available in the RayStation treatment planning system (TPS) and its ability to reduce treatment planning time while providing high dosimetric plan quality. Nine patients with localized prostate cancer who were previously treated with 78 Gy in 39 fractions using VMAT plans and rayArc system based on the direct machine parameter optimization (DMPO) algorithm were selected and replanned using the VMAT‐MCO system. First, the dosimetric quality of the plans was evaluated using multiple conformity metrics that account for target coverage and sparing of healthy tissue, used in our departmental clinical protocols. The conformity and homogeneity index, number of monitor units, and treatment planning time for both modalities were assessed. Next, the effects of the technical plan parameters, such as constraint leaf motion CLM (cm/°) and maximum arc delivery time T (s), on the accuracy of delivered dose were evaluated using quality assurance passing rates (QAs) measured using the Delta4 phantom from ScandiDos. For the dosimetric plan's quality analysis, the results show that the VMAT‐MCO system provides plans comparable to the rayArc system with no statistical difference for V95% (p<0.01), D1% (p<0.01), CI (p<0.01), and HI (p<0.01) of the PTV, bladder (p<0.01), and rectum (p<0.01) constraints, except for the femoral heads and healthy tissues, for which a dose reduction was observed using MCO compared with rayArc (p<0.01). The technical parameter study showed that a combination of CLM equal to 0.5 cm/degree and a maximum delivery time of 72 s allowed the accurate delivery of the VMAT‐MCO plan on the Elekta Versa HD linear accelerator. Planning evaluation and dosimetric measurements showed that VMAT‐MCO can be used clinically with the advantage of enhanced planning process efficiency by reducing the treatment planning time without impairing dosimetric quality. PACS numbers: 87.55.D, 87.55.de, 87.55.Qr
Collapse
Affiliation(s)
- Sarah Ghandour
- Cancer Center - Radiotherapy Department, Riviera-Chablais Hospital.
| | | | | |
Collapse
|
21
|
Schimek-Jasch T, Troost EGC, Rücker G, Prokic V, Avlar M, Duncker-Rohr V, Mix M, Doll C, Grosu AL, Nestle U. A teaching intervention in a contouring dummy run improved target volume delineation in locally advanced non-small cell lung cancer: Reducing the interobserver variability in multicentre clinical studies. Strahlenther Onkol 2015; 191:525-33. [PMID: 25665799 DOI: 10.1007/s00066-015-0812-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/07/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Interobserver variability in the definition of target volumes (TVs) is a well-known confounding factor in (multicentre) clinical studies employing radiotherapy. Therefore, detailed contouring guidelines are provided in the prospective randomised multicentre PET-Plan (NCT00697333) clinical trial protocol. This trial compares strictly FDG-PET-based TV delineation with conventional TV delineation in patients with locally advanced non-small cell lung cancer (NSCLC). Despite detailed contouring guidelines, their interpretation by different radiation oncologists can vary considerably, leading to undesirable discrepancies in TV delineation. Considering this, as part of the PET-Plan study quality assurance (QA), a contouring dummy run (DR) consisting of two phases was performed to analyse the interobserver variability before and after teaching. MATERIALS AND METHODS In the first phase of the DR (DR1), radiation oncologists from 14 study centres were asked to delineate TVs as defined by the study protocol (gross TV, GTV; and two clinical TVs, CTV-A and CTV-B) in a test patient. A teaching session was held at a study group meeting, including a discussion of the results focussing on discordances in comparison to the per-protocol solution. Subsequently, the second phase of the DR (DR2) was performed in order to evaluate the impact of teaching. RESULTS Teaching after DR1 resulted in a reduction of absolute TVs in DR2, as well as in better concordance of TVs. The Overall Kappa(κ) indices increased from 0.63 to 0.71 (GTV), 0.60 to 0.65 (CTV-A) and from 0.59 to 0.63 (CTV-B), demonstrating improvements in overall interobserver agreement. CONCLUSION Contouring DRs and study group meetings as part of QA in multicentre clinical trials help to identify misinterpretations of per-protocol TV delineation. Teaching the correct interpretation of protocol contouring guidelines leads to a reduction in interobserver variability and to more consistent contouring, which should consequently improve the validity of the overall study results.
Collapse
Affiliation(s)
- Tanja Schimek-Jasch
- Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Kalpathy-Cramer J, Awan M, Bedrick S, Rasch CRN, Rosenthal DI, Fuller CD. Development of a software for quantitative evaluation radiotherapy target and organ-at-risk segmentation comparison. J Digit Imaging 2014; 27:108-19. [PMID: 24043593 DOI: 10.1007/s10278-013-9633-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Modern radiotherapy requires accurate region of interest (ROI) inputs for plan optimization and delivery. Target delineation, however, remains operator-dependent and potentially serves as a major source of treatment delivery error. In order to optimize this critical, yet observer-driven process, a flexible web-based platform for individual and cooperative target delineation analysis and instruction was developed in order to meet the following unmet needs: (1) an open-source/open-access platform for automated/semiautomated quantitative interobserver and intraobserver ROI analysis and comparison, (2) a real-time interface for radiation oncology trainee online self-education in ROI definition, and (3) a source for pilot data to develop and validate quality metrics for institutional and cooperative group quality assurance efforts. The resultant software, Target Contour Testing/Instructional Computer Software (TaCTICS), developed using Ruby on Rails, has since been implemented and proven flexible, feasible, and useful in several distinct analytical and research applications.
Collapse
Affiliation(s)
- Jayashree Kalpathy-Cramer
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Harvard Medical School, Department of Radiology and Neuroscience, Massachusetts General Hospital, Charlestown, MA, USA
| | | | | | | | | | | |
Collapse
|
23
|
Joye I, Lambrecht M, Jegou D, Hortobágyi E, Scalliet P, Haustermans K. Does a central review platform improve the quality of radiotherapy for rectal cancer? Results of a national quality assurance project. Radiother Oncol 2014; 111:400-5. [PMID: 24746578 DOI: 10.1016/j.radonc.2014.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 02/12/2014] [Accepted: 03/04/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE Quality assurance (QA) for radiation treatment has become a priority since poorly delivered radiotherapy can negatively influence patient outcome. Within a national project we evaluated the feasibility of a central review platform and its role in improving uniformity of clinical target volume (CTV) delineation in daily practice. MATERIAL AND METHODS All Belgian radiotherapy departments were invited to participate and were asked to upload CTVs for rectal cancer treatment onto a secured server. These were centrally reviewed and feedback was given per e-mail. For each five consecutive patients per centre, the overlap parameter dice coefficient (DC) and the volumetric parameters volumetric ratio (RV) and commonly contoured volume (VCC) were calculated. RESULTS Twenty departments submitted 1224 eligible cases of which 909 were modified (74.3%). There was a significant increase in RV and VCC between the first ten patients per centre and the others. This was not seen for DC. Statistical analysis did not show a further significant improvement in delineation over the entire review period. CONCLUSION Central review was feasible and increased the uniformity in CTV delineation in the first ten rectal cancer patients per centre. The observations in this study can be used to optimize future QA initiatives.
Collapse
Affiliation(s)
- Ines Joye
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium
| | - Maarten Lambrecht
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium
| | - David Jegou
- Department of Research, Belgian Cancer Registry, Brussels, Belgium
| | - Eszter Hortobágyi
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium
| | - Pierre Scalliet
- Department of Radiation Oncology, Université Catholique de Louvain, Brussels, Belgium
| | - Karin Haustermans
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium.
| |
Collapse
|
24
|
Kristensen I, Agrup M, Bergström P, Engellau J, Haugen H, Martinsson U, Nilsson K, Taheri-Kadkhoda Z, Lindh J, Nilsson P. Assessment of volume segmentation in radiotherapy of adolescents; a treatment planning study by the Swedish Workgroup for Paediatric Radiotherapy. Acta Oncol 2014; 53:126-33. [PMID: 23577745 DOI: 10.3109/0284186x.2013.782104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND PURPOSE The variability in target delineation for similar cases between centres treating paediatric and adolescent patients, and the apparent differences in interpretation of radiotherapy guidelines in the treatment protocols encouraged us to perform a dummy-run study as a part of our quality assurance work. The aim was to identify and quantify differences in the segmentation of target volumes and organs at risk (OARs) and to analyse the treatment plans and dose distributions. MATERIALS AND METHODS Four patient cases were selected: Wilm's tumour, Hodgkin's disease, rhabdomyosarcoma of the prostate and chordoma of the skull base. The five participating centres received the same patient-related material. They introduced the cases in their treatment planning system, delineated target volumes and OARs and created treatment plans. Dose-volume histograms were retrieved for relevant structures and volumes and dose metrics were derived and compared, e.g. target volumes and their concordance, dose homogeneity index (HI), treated and irradiated volumes, remaining volume at risk and relevant Vx and Dx values. RESULTS We found significant differences in target segmentation in the majority of the cases. The planning target volumes (PTVs) varied two- to four-fold and conformity indices were in the range of 0.3-0.6. This resulted in large variations in dose distributions to OARs as well as in treated and irradiated volumes even though the treatment plans showed good conformity to the PTVs. Potential reasons for the differences in target delineation were analysed. CONCLUSION Considerations of the growing child and difficulties in interpretation of the radiotherapy information in the treatment protocols were identified as reasons for the variation. As a result, clarified translated detailed radiotherapy guidelines for paediatric/adolescent patients have been recognised as a way to reduce this variation.
Collapse
Affiliation(s)
- Ingrid Kristensen
- Department of Clinical Sciences, Oncology, Lund University , Lund , Sweden
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Fairchild A, Straube W, Laurie F, Followill D. Does quality of radiation therapy predict outcomes of multicenter cooperative group trials? A literature review. Int J Radiat Oncol Biol Phys 2013; 87:246-60. [PMID: 23683829 PMCID: PMC3749289 DOI: 10.1016/j.ijrobp.2013.03.036] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 03/29/2013] [Accepted: 03/31/2013] [Indexed: 10/26/2022]
Abstract
Central review of radiation therapy (RT) delivery within multicenter clinical trials was initiated in the early 1970s in the United States. Early quality assurance publications often focused on metrics related to process, logistics, and timing. Our objective was to review the available evidence supporting correlation of RT quality with clinical outcomes within cooperative group trials. A MEDLINE search was performed to identify multicenter studies that described central subjective assessment of RT protocol compliance (quality). Data abstracted included method of central review, definition of deviations, and clinical outcomes. Seventeen multicenter studies (1980-2012) were identified, plus one Patterns of Care Study. Disease sites were hematologic, head and neck, lung, breast, and pancreas. Between 0 and 97% of treatment plans received an overall grade of acceptable. In 7 trials, failure rates were significantly higher after inadequate versus adequate RT. Five of 9 and 2 of 5 trials reported significantly worse overall and progression-free survival after poor-quality RT, respectively. One reported a significant correlation, and 2 reported nonsignificant trends toward increased toxicity with noncompliant RT. Although more data are required, protocol-compliant RT may decrease failure rates and increase overall survival and likely contributes to the ability of collected data to answer the central trial question.
Collapse
Affiliation(s)
- Alysa Fairchild
- Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada.
| | | | | | | |
Collapse
|
26
|
Sassowsky M, Gut P, Hölscher T, Hildebrandt G, Müller AC, Najafi Y, Kohler G, Kranzbühler H, Guckenberger M, Zwahlen DR, Azinwi NC, Plasswilm L, Takacs I, Reuter C, Sumila M, Manser P, Ost P, Böhmer D, Pilop C, Aebersold DM, Ghadjar P. Use of EORTC target definition guidelines for dose-intensified salvage radiation therapy for recurrent prostate cancer: results of the quality assurance program of the randomized trial SAKK 09/10. Int J Radiat Oncol Biol Phys 2013; 87:534-41. [PMID: 23972722 DOI: 10.1016/j.ijrobp.2013.06.2053] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 06/18/2013] [Accepted: 06/22/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE Different international target volume delineation guidelines exist and different treatment techniques are available for salvage radiation therapy (RT) for recurrent prostate cancer, but less is known regarding their respective applicability in clinical practice. METHODS AND MATERIALS A randomized phase III trial testing 64 Gy vs 70 Gy salvage RT was accompanied by an intense quality assurance program including a site-specific and study-specific questionnaire and a dummy run (DR). Target volume delineation was performed according to the European Organisation for the Research and Treatment of Cancer guidelines, and a DR-based treatment plan was established for 70 Gy. Major and minor protocol deviations were noted, interobserver agreement of delineated target contours was assessed, and dose-volume histogram (DVH) parameters of different treatment techniques were compared. RESULTS Thirty European centers participated, 43% of which were using 3-dimensional conformal RT (3D-CRT), with the remaining centers using intensity modulated RT (IMRT) or volumetric modulated arc technique (VMAT). The first submitted version of the DR contained major deviations in 21 of 30 (70%) centers, mostly caused by inappropriately defined or lack of prostate bed (PB). All but 5 centers completed the DR successfully with their second submitted version. The interobserver agreement of the PB was moderate and was improved by the DR review, as indicated by an increased κ value (0.59 vs 0.55), mean sensitivity (0.64 vs 0.58), volume of total agreement (3.9 vs 3.3 cm(3)), and decrease in the union volume (79.3 vs 84.2 cm(3)). Rectal and bladder wall DVH parameters of IMRT and VMAT vs 3D-CRT plans were not significantly different. CONCLUSIONS The interobserver agreement of PB delineation was moderate but was improved by the DR. Major deviations could be identified for the majority of centers. The DR has improved the acquaintance of the participating centers with the trial protocol.
Collapse
Affiliation(s)
- Manfred Sassowsky
- Department of Radiation Oncology and Division of Medical Radiation Physics, Bern University Hospital, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Prospective multi-center dosimetry study of low-dose Iodine-125 prostate brachytherapy performed after transurethral resection. J Contemp Brachytherapy 2013; 5:63-9. [PMID: 23878549 PMCID: PMC3708148 DOI: 10.5114/jcb.2013.36174] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 06/05/2013] [Accepted: 06/25/2013] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate in a multicenter setting the ability of centers to perform pre-implant permanent prostate brachytherapy planning, fulfilling dosimetric goals and constraints based on the Groupe de Curiethérapie-European Society for Radiotherapy and Oncology guidelines in the setting of implantation after prior prostate transurethral resection (TURP). Material and methods A reference transrectal ultrasound image set of the prostate gland from a patient who had undergone TURP was used. Contouring of the prostate, clinical target volume and organs at risk was performed by the coordinating center. Goals and constraints regarding the dosimetry were defined. Results Seventeen of twenty-five centers invited to participate were able to import the Digital Imaging and Communications in Medicine-images into their planning computer and plan the implant using the defined guidelines. All centers were able to plan treatment, and achieve the recommended objectives and constraints. However, sector analysis has shown a risk of under-dosage in the anterior part of the prostate. Conclusions Correct pre-implantation planning with adherence to protocol guidelines and in compliance with defined dosimetric constraints seems feasible in a post-TURP setting, at least on a theoretical basis. A prospective study evaluating the outcome of prostate brachytherapy performed after TURP can therefore be undertaken with an expectation of a correct dosimetry in the multicenter setting.
Collapse
|
28
|
Quality assurance of the EORTC 22043-30041 trial in post-operative radiotherapy in prostate cancer: Results of the Dummy Run procedure. Radiother Oncol 2013; 107:346-51. [DOI: 10.1016/j.radonc.2013.04.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 03/20/2013] [Accepted: 04/27/2013] [Indexed: 11/13/2022]
|
29
|
Geraghty JP, Grogan G, Ebert MA. Automatic segmentation of male pelvic anatomy on computed tomography images: a comparison with multiple observers in the context of a multicentre clinical trial. Radiat Oncol 2013; 8:106. [PMID: 23631832 PMCID: PMC3653737 DOI: 10.1186/1748-717x-8-106] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 04/19/2013] [Indexed: 11/12/2022] Open
Abstract
Background This study investigates the variation in segmentation of several pelvic anatomical structures on computed tomography (CT) between multiple observers and a commercial automatic segmentation method, in the context of quality assurance and evaluation during a multicentre clinical trial. Methods CT scans of two prostate cancer patients (‘benchmarking cases’), one high risk (HR) and one intermediate risk (IR), were sent to multiple radiotherapy centres for segmentation of prostate, rectum and bladder structures according to the TROG 03.04 “RADAR” trial protocol definitions. The same structures were automatically segmented using iPlan software for the same two patients, allowing structures defined by automatic segmentation to be quantitatively compared with those defined by multiple observers. A sample of twenty trial patient datasets were also used to automatically generate anatomical structures for quantitative comparison with structures defined by individual observers for the same datasets. Results There was considerable agreement amongst all observers and automatic segmentation of the benchmarking cases for bladder (mean spatial variations < 0.4 cm across the majority of image slices). Although there was some variation in interpretation of the superior-inferior (cranio-caudal) extent of rectum, human-observer contours were typically within a mean 0.6 cm of automatically-defined contours. Prostate structures were more consistent for the HR case than the IR case with all human observers segmenting a prostate with considerably more volume (mean +113.3%) than that automatically segmented. Similar results were seen across the twenty sample datasets, with disagreement between iPlan and observers dominant at the prostatic apex and superior part of the rectum, which is consistent with observations made during quality assurance reviews during the trial. Conclusions This study has demonstrated quantitative analysis for comparison of multi-observer segmentation studies. For automatic segmentation algorithms based on image-registration as in iPlan, it is apparent that agreement between observer and automatic segmentation will be a function of patient-specific image characteristics, particularly for anatomy with poor contrast definition. For this reason, it is suggested that automatic registration based on transformation of a single reference dataset adds a significant systematic bias to the resulting volumes and their use in the context of a multicentre trial should be carefully considered.
Collapse
Affiliation(s)
- John P Geraghty
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | | | | |
Collapse
|
30
|
Kearvell R, Haworth A, Ebert MA, Murray J, Hooton B, Richardson S, Joseph DJ, Lamb D, Spry NA, Duchesne G, Denham JW. Quality improvements in prostate radiotherapy: Outcomes and impact of comprehensive quality assurance during the TROG 03.04 ‘RADAR’ trial. J Med Imaging Radiat Oncol 2013; 57:247-57. [DOI: 10.1111/1754-9485.12025] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 10/01/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Rachel Kearvell
- Department of Radiation Oncology; Sir Charles Gairdner Hospital; Nedlands; Western Australia; Australia
| | | | | | - Judy Murray
- Department of Pathology and Molecular Medicine; University of Otago; Wellington; New Zealand
| | - Ben Hooton
- Department of Radiation Oncology; Sir Charles Gairdner Hospital; Nedlands; Western Australia; Australia
| | - Sharon Richardson
- Department of Radiation Oncology; Sir Charles Gairdner Hospital; Nedlands; Western Australia; Australia
| | | | - David Lamb
- Department of Pathology and Molecular Medicine; University of Otago; Wellington; New Zealand
| | | | | | - James W Denham
- School of Medicine and Public Health; University of Newcastle; Callaghan; New South Wales; Australia
| |
Collapse
|
31
|
Fairchild A, Collette L, Hurkmans C, Baumert B, Weber D, Gulyban A, Poortmans P. Do results of the EORTC dummy run predict quality of radiotherapy delivered within multicentre clinical trials? Eur J Cancer 2012; 48:3232-9. [DOI: 10.1016/j.ejca.2012.06.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 04/26/2012] [Accepted: 06/01/2012] [Indexed: 10/28/2022]
|
32
|
Batumalai V, Jameson MG, Forstner DF, Vial P, Holloway LC. How important is dosimetrist experience for intensity modulated radiation therapy? A comparative analysis of a head and neck case. Pract Radiat Oncol 2012; 3:e99-e106. [PMID: 24674377 DOI: 10.1016/j.prro.2012.06.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 06/04/2012] [Accepted: 06/22/2012] [Indexed: 02/07/2023]
Abstract
PURPOSE Treatment planning for IMRT is a complex process that requires additional training and expertise. The aim of this study was to compare and analyze IMRT plans generated by dosimetrists with varying levels of IMRT planning experience. METHODS AND MATERIALS The computed tomography (CT) data of a patient previously treated with IMRT for left tonsillar carcinoma were used. The patient's preexisting planning target volumes (PTVs) and all organs at risk were provided with the CT data set. Six dosimetrists with variable IMRT planning experience generated IMRT plans according to the department's protocol. Plan analysis included visual inspection and comparison of dose-volume histogram, conformity indices, treatment delivery efficiency, and dose delivery accuracy. RESULTS Visual review of the dose distribution showed that the 6 plans were comparable. However, only the 2 most experienced dosimetrists were able to meet the strict PTV aims and critical structure constraints. The least experienced dosimetrist had the worst planning outcome. Comparison of delivery efficiency showed that the number of segments, total monitor units, and treatment time increased as the IMRT planning experience decreased. CONCLUSIONS Dosimetrists with higher levels of IMRT planning experience produced a better quality head and neck IMRT plan. Different planning experience may need to be considered when organizing appropriate departmental resources.
Collapse
Affiliation(s)
- Vikneswary Batumalai
- Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia; University of New South Wales, NSW, Australia.
| | - Michael G Jameson
- Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - Dion F Forstner
- Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia; Collaboration of Cancer Outcome Research and Evaluation (CCORE), Liverpool Hospital, Sydney, Australia
| | - Philip Vial
- Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia; Institute of Medical Physics, School of Medical Physics, University of Sydney, Sydney, Australia
| | - Lois C Holloway
- Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia; University of New South Wales, NSW, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia; Institute of Medical Physics, School of Medical Physics, University of Sydney, Sydney, Australia
| |
Collapse
|
33
|
Kron T, Pham D, Roxby P, Rolfo A, Foroudi F. Credentialing of radiotherapy centres for a clinical trial of adaptive radiotherapy for bladder cancer (TROG 10.01). Radiother Oncol 2012; 103:293-8. [DOI: 10.1016/j.radonc.2012.03.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 02/12/2012] [Accepted: 03/07/2012] [Indexed: 10/28/2022]
|
34
|
Quality assurance in the EORTC 22033–26033/CE5 phase III randomized trial for low grade glioma: The digital individual case review. Radiother Oncol 2012; 103:287-92. [DOI: 10.1016/j.radonc.2012.04.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 02/20/2012] [Accepted: 04/03/2012] [Indexed: 11/17/2022]
|
35
|
EORTC Radiation Oncology Group quality assurance platform: establishment of a digital central review facility. Radiother Oncol 2012; 103:279-86. [PMID: 22633815 DOI: 10.1016/j.radonc.2012.04.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Revised: 04/10/2012] [Accepted: 04/24/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Quality assurance (QA) in clinical trials is essential to ensure treatment is safely and effectively delivered. As QA requirements have increased in complexity in parallel with evolution of radiation therapy (RT) delivery, a need to facilitate digital data exchange emerged. Our objective is to present the platform developed for the integration and standardization of QART activities across all EORTC trials involving RT. METHODS The following essential requirements were identified: secure and easy access without on-site software installation; integration within the existing EORTC clinical remote data capture system; and the ability to both customize the platform to specific studies and adapt to future needs. After retrospective testing within several clinical trials, the platform was introduced in phases to participating sites and QART study reviewers. RESULTS The resulting QA platform, integrating RT analysis software installed at EORTC Headquarters, permits timely, secure, and fully digital central DICOM-RT based data review. Participating sites submit data through a standard secure upload webpage. Supplemental information is submitted in parallel through web-based forms. An internal quality check by the QART office verifies data consistency, formatting, and anonymization. QART reviewers have remote access through a terminal server. Reviewers evaluate submissions for protocol compliance through an online evaluation matrix. Comments are collected by the coordinating centre and institutions are informed of the results. CONCLUSIONS This web-based central review platform facilitates rapid, extensive, and prospective QART review. This reduces the risk that trial outcomes are compromised through inadequate radiotherapy and facilitates correlation of results with clinical outcomes.
Collapse
|
36
|
Fairchild A, Bar-Deroma R, Collette L, Haustermans K, Hurkmans C, Lacombe D, Maingon P, Poortmans P, Tomsej M, Weber DC, Gregoire V. Development of clinical trial protocols involving advanced radiation therapy techniques: the European Organisation for Research and Treatment of Cancer Radiation Oncology Group approach. Eur J Cancer 2012; 48:1048-54. [PMID: 22387181 DOI: 10.1016/j.ejca.2012.02.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 02/09/2012] [Indexed: 12/25/2022]
Abstract
The European Organisation for Research and Treatment of Cancer (EORTC) Master Protocol for phase III radiation therapy (RT) studies was published in 1995 to define in a consistent sequence the parameters which must be addressed when designing a phase III trial 'from the rationale to the references'. This was originally implemented to assist study investigators and writing committees, and to increase homogeneity within Radiation Oncology Group (ROG) study protocols. However, RT planning, delivery, treatment verification and quality assurance (QA) have evolved significantly over the last 15 years and clinical trial protocols must reflect these developments. The goal of this update is to describe the incorporation of these developments into the EORTC-ROG protocol template. Implementation of QA procedures for advanced RT trials is also briefly described as these essential elements must also be clearly articulated. This guide may assist both investigators participating in current ROG trials and others involved in writing an advanced RT trial protocol.
Collapse
|
37
|
Grégoire V, Bartelink H, Bernier J, Bolla M, Bosset JF, Collette L, Haustermans K, Horiot JC, Hurkmans CW, Mirimanoff R, Poortmans P, Weber DC, Maingon P. EORTC Radiation Oncology Group: 50 years of continuous accomplishments. EJC Suppl 2012. [DOI: 10.1016/s1359-6349(12)70024-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
38
|
Functional Outcomes and Complications Following Radiation Therapy for Prostate Cancer: A Critical Analysis of the Literature. Eur Urol 2012; 61:112-27. [DOI: 10.1016/j.eururo.2011.09.027] [Citation(s) in RCA: 211] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 09/27/2011] [Indexed: 12/13/2022]
|
39
|
Dewas S, Bibault JE, Blanchard P, Vautravers-Dewas C, Pointreau Y, Denis F, Brauner M, Giraud P. Delineation in thoracic oncology: a prospective study of the effect of training on contour variability and dosimetric consequences. Radiat Oncol 2011; 6:118. [PMID: 21929770 PMCID: PMC3195101 DOI: 10.1186/1748-717x-6-118] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 09/19/2011] [Indexed: 12/17/2022] Open
Abstract
Introduction As part of French residents' radiotherapy training, delineation workstations were available at a national teaching course. We report a prospective comparative study of a non small cell lung cancer (NSCLC) case delineated by 120 residents before and after a radioanatomy/radiotherapy lecture. Materials and methods The case of a patient with right upper lobe non small cell lung cancer (NSCLC) was provided for delineation to 32 groups of residents before and after a radiation therapy lecture about thoracic delineation. GTV, CTV and PTV was asked to each group. In a second step, the GTV, CTV and PTV were compared with those of 9 groups of senior physicians. Finally the consequences for treatment planning between each group before and after the course were explored. Results The expert's average GTV, CTV and PTV were 89.1 cm3, 242.3 cm3 and 293.9 cm3 respectively. For residents, those volumes were 103.4 cm3, 242.3 cm3 and 457.9 cm3 before teaching, compared to 99.5 cm3, 224.2 cm3 and 412.5 cm3 after teaching. The overlap (OV) and kappa (KI) indices before and after education were respectively 0.58 and 0.73. Compared to senior physicians, OV and KI indices were lower in the residents group (p = 0.039 and p = 0.043). An increased dose to the lung is noted for the residents' dosimetry compared to the experts' (V20: 23.2% versus 36.5%) due to the larger PTV delineated. No significant difference was observed for other organs at risk. Conclusion There were no significant differences for the delineation of the GTV and CTV before and after the course, although the differences tended to decrease after the course. The good initial quality of the contours could explain the lack of difference. V20 for lung was higher in the residents group compared to the experts group (23.2% vs 36.5%). No other treatment planning consequences were observed for other critical organs.
Collapse
Affiliation(s)
- Sylvain Dewas
- Département universitaire de Radiothérapie, Centre Oscar Lambret, Université Lille II, Lille, France.
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Quality assurance for prospective EORTC radiation oncology trials: The challenges of advanced technology in a multicenter international setting. Radiother Oncol 2011; 100:150-6. [DOI: 10.1016/j.radonc.2011.05.073] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 05/23/2011] [Accepted: 05/29/2011] [Indexed: 11/20/2022]
|
41
|
Sanuki N, Ishikura S, Shinoda M, Ito Y, Hayakawa K, Ando N. Radiotherapy quality assurance review for a multi-center randomized trial of locally advanced esophageal cancer: the Japan Clinical Oncology Group (JCOG) trial 0303. Int J Clin Oncol 2011; 17:105-11. [PMID: 21667354 DOI: 10.1007/s10147-011-0264-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 05/24/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to evaluate the radiotherapy (RT) quality assurance (QA) for JCOG 0303. METHODS AND MATERIALS JCOG 0303 was a multi-center phase II/III trial that compared two types of chemotherapy administered concomitantly with RT for locally advanced esophageal cancer. RT requirements included a total dose of 60 Gy in 30 fractions and CTV with a 2-cm margin cranio-caudally to the primary tumor. The QA assessment was given as per protocol (PP), deviation acceptable (DA), violation unacceptable (VU), and incomplete/not evaluable following predefined criteria for quality parameters. RESULTS A total of 142 cases were accrued. After excluding 36 incomplete/not evaluable, 106 (75%) were fully evaluable for RT quality review. Of these 106, there were 4 VU (4%) and overall RT compliance (PP + DA) was 96%. Comparing the incidence of VU based on the numbers enrolled by institution, the highest quarter of enrollment (≥7 cases) had no VU, while all VU (4; 11%) were from institutions enrolling <7 patients. CONCLUSIONS The results of the RTQA assessment for JCOG 0303 were sufficient to provide reliable results. Additional improvements will be needed for institutions with low accrual rates.
Collapse
Affiliation(s)
- Naoko Sanuki
- Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | | | | | | | | | | |
Collapse
|
42
|
Interobserver variability of clinical target volume delineation in supra-diaphragmatic Hodgkin's disease: a multi-institutional experience. Strahlenther Onkol 2011; 187:357-66. [PMID: 21603989 DOI: 10.1007/s00066-011-2221-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND To determine interobserver variability in clinical target volume (CTV) of supra-diaphragmatic Hodgkin's lymphoma. MATERIALS AND METHODS At the 2008 AIRO (Italian Society of Radiation Oncology) Meeting, the Radiation Oncology Department of Chieti proposed a multi-institutional contouring dummy-run of two cases of early stage supra-diaphragmatic Hodgkin's lymphoma after chemotherapy. Clinical history, diagnostics, and planning CT imaging were available on Chieti's radiotherapy website (www.radioterapia.unich.it). Participating centers were requested to delineate the CTV and submit it to the coordinating center. To quantify interobserver variability of CTV delineations, the total volume, craniocaudal, laterolateral, and anteroposterior diameters were calculated. RESULTS A total of 18 institutions for case A and 15 institutions for case B submitted the targets. Case A presented significant variability in total volume (range: 74.1-1,157.1 cc), craniocaudal (range: 6.5-22.5 cm; median: 16.25 cm), anteroposterior (range: 5.04-14.82 cm; median: 10.28 cm), and laterolateral diameters (range: 8.23-22.88 cm; median: 15.5 cm). Mean CTV was 464.8 cc (standard deviation: 280.5 cc). Case B presented significant variability in total volume (range: 341.8-1,662 cc), cranio-caudal (range: 8.0-28.5 cm; median: 23 cm), anteroposterior (range: 7.9-1.8 cm; median: 11.1 cm), and laterolateral diameters (range: 12.9-24.0 cm; median: 18.8 cm). Mean CTV was 926.0 cc (standard deviation: 445.7 cc). CONCLUSION This significant variability confirms the need to apply specific guidelines to improve contouring uniformity in Hodgkin's lymphoma.
Collapse
|
43
|
Jameson MG, Holloway LC, Vial PJ, Vinod SK, Metcalfe PE. A review of methods of analysis in contouring studies for radiation oncology. J Med Imaging Radiat Oncol 2011; 54:401-10. [PMID: 20958937 DOI: 10.1111/j.1754-9485.2010.02192.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Inter-observer variability in anatomical contouring is the biggest contributor to uncertainty in radiation treatment planning. Contouring studies are frequently performed to investigate the differences between multiple contours on common datasets. There is, however, no widely accepted method for contour comparisons. The purpose of this study is to review the literature on contouring studies in the context of radiation oncology, with particular consideration of the contouring comparison methods they employ. A literature search, not limited by date, was conducted using Medline and Google Scholar with key words: contour, variation, delineation, inter/intra observer, uncertainty and trial dummy-run. This review includes a description of the contouring processes and contour comparison metrics used. The use of different processes and metrics according to tumour site and other factors were also investigated with limitations described. A total of 69 relevant studies were identified. The most common tumour sites were prostate (26), lung (10), head and neck cancers (8) and breast (7).The most common metric of comparison was volume used 59 times, followed by dimension and shape used 36 times, and centre of volume used 19 times. Of all 69 publications, 67 used a combination of metrics and two used only one metric for comparison. No clear relationships between tumour site or any other factors that may influence the contouring process and the metrics used to compare contours were observed from the literature. Further studies are needed to assess the advantages and disadvantages of each metric in various situations.
Collapse
Affiliation(s)
- Michael G Jameson
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia.
| | | | | | | | | |
Collapse
|
44
|
Hatton JA, Greer PB, Tang C, Wright P, Capp A, Gupta S, Parker J, Wratten C, Denham JW. Does the planning dose–volume histogram represent treatment doses in image-guided prostate radiation therapy? Assessment with cone-beam computerised tomography scans. Radiother Oncol 2011; 98:162-8. [DOI: 10.1016/j.radonc.2011.01.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 01/13/2011] [Accepted: 01/13/2011] [Indexed: 11/27/2022]
|
45
|
Musat E, Roelofs E, Bar-Deroma R, Fenton P, Gulyban A, Collette L, Stupp R, Weber DC, Bernard Davis J, Aird E, Baumert BG. Dummy run and conformity indices in the ongoing EORTC low-grade glioma trial 22033-26033: First evaluation of quality of radiotherapy planning. Radiother Oncol 2010; 95:218-24. [DOI: 10.1016/j.radonc.2010.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 02/18/2010] [Accepted: 03/06/2010] [Indexed: 11/16/2022]
|
46
|
Variabilité inter-radiothérapeutes de la délinéation tumorale en oncologie thoracique : exemples d’intercomparaison de délinéations et impact de la formation. Cancer Radiother 2010; 14:103-10. [DOI: 10.1016/j.canrad.2009.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 10/20/2009] [Accepted: 11/14/2009] [Indexed: 11/23/2022]
|
47
|
Matzinger O, Duclos F, Bergh AVD, Carrie C, Villà S, Kitsios P, Poortmans P, Sundar S, van der Steen-Banasik E, Gulyban A, Collette L, Bolla M. Acute toxicity of curative radiotherapy for intermediate- and high-risk localised prostate cancer in the EORTC trial 22991. Eur J Cancer 2009; 45:2825-34. [DOI: 10.1016/j.ejca.2009.07.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 07/14/2009] [Accepted: 07/17/2009] [Indexed: 11/24/2022]
|
48
|
Onal C, Topkan E, Efe E, Yavuz M, Arslan G, Yavuz A. The effect of concurrent androgen deprivation and 3D conformal radiotherapy on prostate volume and clinical organ doses during treatment for prostate cancer. Br J Radiol 2009; 82:1019-26. [PMID: 19581310 DOI: 10.1259/bjr/65939531] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
In this study, we investigated the shrinking effect of concurrent three-dimensional conformal radiotherapy (3D-CRT) and androgen deprivation (AD) on prostate volume, and its possible impact on the dose received by the rectum and bladder during the course of 3D-CRT. The difference between the prostatic volumes determined on pre-treatment planning CT (PL-CT) and post-treatment CT (PT-CT) following a 3D-CRT course was assessed in 52 patients with localised prostate carcinoma. The changes in mean prostate volume when compared with PL-CT and PT-CT-based measurements were assessed. The pre- and post-treatment mean prostate volumes for the whole study population were 49.7 cm(3) and 41.0 cm(3) (p _ 0.02), respectively. The study cohort was divided into two groups depending on the duration of neoadjuvant androgen deprivation (NAD): 23 patients (44.7%) were designated as "short NAD" (< or =3 months; SNAD) and the remaining 29 (55.3%) as "long NAD" (>3 months; LNAD). Patients on SNAD experienced a significantly greater reduction in prostate volume compared with those on LNAD (14.1% vs 5.1%; p _ 0.03). A significant increase in rectum V(40-60) values in PT-CT compared with PL-CT was demonstrated. LNAD patients had significantly higher rectal V(50-70) values at PT-CT compared with the SNAD group. There was a significant decline in V(30)-V(75) bladder values in PT-CT compared with PL-CT in the SNAD group. In conclusion, a higher prostate volume reduction during 3D-CRT was demonstrated when RT planning was performed within 3 months of NAD. However, this reduction and daily organ motion may lead to an unpredictable increase in rectal doses.
Collapse
Affiliation(s)
- C Onal
- Department of Radiation Oncology, Baskent University, Adana, Turkey.
| | | | | | | | | | | |
Collapse
|
49
|
IMRT of prostate cancer: a comparison of fluence optimization with sequential segmentation and direct step-and-shoot optimization. Strahlenther Onkol 2009; 185:379-83. [PMID: 19506821 DOI: 10.1007/s00066-009-1950-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Accepted: 02/12/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE Intensity-modulated radiation therapy (IMRT) has shown its superiority to three-dimensional conformal radiotherapy in the treatment of prostate cancer. Different optimization algorithms are available: algorithms which first optimize the fluence followed by a sequencing (IM), and algorithms which involve the machine parameters directly in the optimization process (DSS). The aim of this treatment-planning study is to compare both of them regarding dose distribution and treatment time. PATIENTS AND METHODS Ten consecutive patients with localized prostate cancer were enrolled for the planning study. The planning target volume and the rectum volume, urinary bladder and femoral heads as organs at risk were delineated. Average doses, the target dose homogeneity H, D(5), D(95), monitor units per fraction, and the number of segments were evaluated. RESULTS While there is only a small difference in the mean doses at rectum and bladder, there is a significant advantage for the target dose homogeneity in the DSS-optimized plans compared to the IM-optimized ones. Differences in the monitor units (nearly 10% less for DSS) and the number of segments are also statistically significant and reduce the treatment time. CONCLUSION Particularly with regard to the tumor control probability, the better homogeneity of the DSS-optimized plans is more profitable. The shorter treatment time is an improvement regarding intrafractional organ motion. The DSS optimizer results in a higher target dose homogeneity and, simultaneously, in a lower number of monitor units. Therefore, it should be preferred for IMRT of prostate cancer.
Collapse
|