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Urethra-Sparing Stereotactic Body Radiation Therapy for Prostate Cancer: Quality Assurance of a Randomized Phase 2 Trial. Int J Radiat Oncol Biol Phys 2020; 108:1047-1054. [PMID: 32535161 DOI: 10.1016/j.ijrobp.2020.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/12/2020] [Accepted: 06/01/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE To present the radiation therapy quality assurance results from a prospective multicenter phase 2 randomized trial of short versus protracted urethra-sparing stereotactic body radiation therapy (SBRT) for localized prostate cancer. METHODS AND MATERIALS Between 2012 and 2015, 165 patients with prostate cancer from 9 centers were randomized and treated with SBRT delivered either every other day (arm A, n = 82) or once a week (arm B, n = 83); 36.25 Gy in 5 fractions were prescribed to the prostate with (n = 92) or without (n = 73) inclusion of the seminal vesicles (SV), and the urethra planning-risk volume received 32.5 Gy. Patients were treated either with volumetric modulated arc therapy (VMAT; n = 112) or with intensity modulated radiation therapy (IMRT; n = 53). Deviations from protocol dose constraints, planning target volume (PTV) homogeneity index, PTV Dice similarity coefficient, and number of monitor units for each treatment plan were retrospectively analyzed. Dosimetric results of VMAT versus IMRT and treatment plans with versus without inclusion of SV were compared. RESULTS At least 1 major protocol deviation occurred in 51 patients (31%), whereas none was observed in 41. Protocol violations were more frequent in the IMRT group (P < .001). Furthermore, the use of VMAT yielded better dosimetric results than IMRT for urethra planning-risk volume D98% (31.1 vs 30.8 Gy, P < .0001), PTV D2% (37.9 vs 38.7 Gy, P < .0001), homogeneity index (0.09 vs 0.10, P < .0001), Dice similarity coefficient (0.83 vs 0.80, P < .0001), and bladder wall V50% (24.5% vs 33.5%, P = .0001). To achieve its goals volumetric modulated arc therapy required fewer monitor units than IMRT (2275 vs 3378, P <.0001). The inclusion of SV in the PTV negatively affected the rectal wall V90% (9.1% vs 10.4%, P = .0003) and V80% (13.2% vs 15.7%, P = .0003). CONCLUSIONS Protocol deviations with potential impact on tumor control or toxicity occurred in 31% of patients in this prospective clinical trial. Protocol deviations were more frequent with IMRT. Prospective radiation therapy quality assurance protocols should be strongly recommended for SBRT trials to minimize potential protocol deviations.
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Gong YUT, Yu J, Pang D, Zhen H, Galvin J, Xiao Y. Automated Extraction of Dose/Volume Statistics for Radiotherapy-Treatment-Plan Evaluation in Clinical-Trial Quality Assurance. Front Oncol 2016; 6:47. [PMID: 26973814 PMCID: PMC4776636 DOI: 10.3389/fonc.2016.00047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 02/16/2016] [Indexed: 12/25/2022] Open
Abstract
Radiotherapy clinical-trial quality assurance is a crucial yet challenging process. This note presents a tool that automatically extracts dose/volume statistics for determining dosimetry compliance review with improved efficiency and accuracy. A major objective of this study is to develop an automated solution for clinical-trial radiotherapy dosimetry review.
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Affiliation(s)
| | - Jialu Yu
- IROC, Philadelphia, PA, USA; Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Dalong Pang
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Heming Zhen
- Rush University Medical Center , Chicago, IL , USA
| | | | - Ying Xiao
- IROC, Philadelphia, PA, USA; Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
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Peters LJ, O'Sullivan B, Giralt J, Fitzgerald TJ, Trotti A, Bernier J, Bourhis J, Yuen K, Fisher R, Rischin D. Critical Impact of Radiotherapy Protocol Compliance and Quality in the Treatment of Advanced Head and Neck Cancer: Results From TROG 02.02. J Clin Oncol 2010; 28:2996-3001. [DOI: 10.1200/jco.2009.27.4498] [Citation(s) in RCA: 577] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To report the impact of radiotherapy quality on outcome in a large international phase III trial evaluating radiotherapy with concurrent cisplatin plus tirapazamine for advanced head and neck cancer. Patients and Methods The protocol required interventional review of radiotherapy plans by the Quality Assurance Review Center (QARC). All plans and radiotherapy documentation underwent post-treatment review by the Trial Management Committee (TMC) for protocol compliance. Secondary review of noncompliant plans for predicted impact on tumor control was performed. Factors associated with poor protocol compliance were studied, and outcome data were analyzed in relation to protocol compliance and radiotherapy quality. Results At TMC review, 25.4% of the patients had noncompliant plans but none in which QARC-recommended changes had been made. At secondary review, 47% of noncompliant plans (12% overall) had deficiencies with a predicted major adverse impact on tumor control. Major deficiencies were unrelated to tumor subsite or to T or N stage (if N+), but were highly correlated with number of patients enrolled at the treatment center (< five patients, 29.8%; ≥ 20 patients, 5.4%; P < .001). In patients who received at least 60 Gy, those with major deficiencies in their treatment plans (n = 87) had a markedly inferior outcome compared with those whose treatment was initially protocol compliant (n = 502): −2 years overall survival, 50% v 70%; hazard ratio (HR), 1.99; P < .001; and 2 years freedom from locoregional failure, 54% v 78%; HR, 2.37; P < .001, respectively. Conclusion These results demonstrate the critical importance of radiotherapy quality on outcome of chemoradiotherapy in head and neck cancer. Centers treating only a few patients are the major source of quality problems.
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Affiliation(s)
- Lester J. Peters
- From the Departments of Radiation Oncology and Medical Oncology, and Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia; Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Radiation Oncology, Hospital General Vall d'Hebron, Barcelona, Spain; Department of Radiation Oncology, University of Massachusetts Medical Center, North Worcester, MA; Department of Radiation Oncology, H. Lee
| | - Brian O'Sullivan
- From the Departments of Radiation Oncology and Medical Oncology, and Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia; Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Radiation Oncology, Hospital General Vall d'Hebron, Barcelona, Spain; Department of Radiation Oncology, University of Massachusetts Medical Center, North Worcester, MA; Department of Radiation Oncology, H. Lee
| | - Jordi Giralt
- From the Departments of Radiation Oncology and Medical Oncology, and Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia; Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Radiation Oncology, Hospital General Vall d'Hebron, Barcelona, Spain; Department of Radiation Oncology, University of Massachusetts Medical Center, North Worcester, MA; Department of Radiation Oncology, H. Lee
| | - Thomas J. Fitzgerald
- From the Departments of Radiation Oncology and Medical Oncology, and Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia; Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Radiation Oncology, Hospital General Vall d'Hebron, Barcelona, Spain; Department of Radiation Oncology, University of Massachusetts Medical Center, North Worcester, MA; Department of Radiation Oncology, H. Lee
| | - Andy Trotti
- From the Departments of Radiation Oncology and Medical Oncology, and Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia; Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Radiation Oncology, Hospital General Vall d'Hebron, Barcelona, Spain; Department of Radiation Oncology, University of Massachusetts Medical Center, North Worcester, MA; Department of Radiation Oncology, H. Lee
| | - Jacques Bernier
- From the Departments of Radiation Oncology and Medical Oncology, and Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia; Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Radiation Oncology, Hospital General Vall d'Hebron, Barcelona, Spain; Department of Radiation Oncology, University of Massachusetts Medical Center, North Worcester, MA; Department of Radiation Oncology, H. Lee
| | - Jean Bourhis
- From the Departments of Radiation Oncology and Medical Oncology, and Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia; Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Radiation Oncology, Hospital General Vall d'Hebron, Barcelona, Spain; Department of Radiation Oncology, University of Massachusetts Medical Center, North Worcester, MA; Department of Radiation Oncology, H. Lee
| | - Kally Yuen
- From the Departments of Radiation Oncology and Medical Oncology, and Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia; Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Radiation Oncology, Hospital General Vall d'Hebron, Barcelona, Spain; Department of Radiation Oncology, University of Massachusetts Medical Center, North Worcester, MA; Department of Radiation Oncology, H. Lee
| | - Richard Fisher
- From the Departments of Radiation Oncology and Medical Oncology, and Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia; Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Radiation Oncology, Hospital General Vall d'Hebron, Barcelona, Spain; Department of Radiation Oncology, University of Massachusetts Medical Center, North Worcester, MA; Department of Radiation Oncology, H. Lee
| | - Danny Rischin
- From the Departments of Radiation Oncology and Medical Oncology, and Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia; Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Radiation Oncology, Hospital General Vall d'Hebron, Barcelona, Spain; Department of Radiation Oncology, University of Massachusetts Medical Center, North Worcester, MA; Department of Radiation Oncology, H. Lee
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Mayer R, Handl-Zeller L, Quehenberger F, Hammer J, Kametriser G, Kolbabek H, Petrova-Schuman K, Raunik W, Rhomberg W, Schratter-Sehn A, Hackl A, Pötter R. Patterns of care in radiotherapy of breast cancer in Austria 1985: data acquisition and comparison with data of US-PCS 1983. Radiother Oncol 2004; 72:45-51. [PMID: 15236873 DOI: 10.1016/j.radonc.2004.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2003] [Revised: 03/26/2004] [Accepted: 04/26/2004] [Indexed: 11/17/2022]
Abstract
PURPOSE In Austria, a Patterns of Care Study (PCS) has been conducted to evaluate the standards of practice for breast cancer patients. The year 1985 was selected in order to establish a base data set. MATERIALS AND METHODS At all nine radiation therapy facilities active in patient treatment in 1985, ten patients charts were randomly selected and reviewed. Evaluation of the radiotherapeutic standards was the principal purpose, however, surgical and histopathological parameters were also considered. RESULTS Results of the Austrian PCS (including 90 patients) were compared with the "1983 Patterns of Care Process Survey for Definitive Breast Irradiation" performed in 1983 in the U.S. (including 191 patients). Documentation of pathologic tumour size (83% vs. 73%), histologic tumour subtype (99% vs. 97%) and microscopic margin analysis (60% vs. 51%) showed comparable results. Technical equipment was obviously quite different in the two countries, cobalt therapy was used in 25% in the US-PCS compared to 71% in the Austrian PCS. A clear difference also was obtained concerning the use of wedges for tangential breast/thoracic wall fields (64% vs. 21%) and the frequency of portal films (93% vs. 26%). CONCLUSIONS Comparing both PCS studies, we found overall many similarities. Differences could be obtained in the quality level of radiation treatment, as for example use of wedges for tangential fields and the number of portal films. In a next step, a further Austrian PCS is planned to compare the Austrian base data from 1985 with quality standards from 1993 and 2001.
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Affiliation(s)
- Ramona Mayer
- Department of Radiation Oncology, University Medical School of Graz, Auenbruggerplatz 32, A-8036 Graz, Austria
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