Radiotherapy quality assurance in the TROG 12.01 randomised trial and its impact on loco-regional failure

June Corry^{1

2

3}, Alisha Moore⁴, Liz Kenny^{5

6}, Chris Wratten⁷, Tsien Fua³, Charles Lin⁵, Sandro Porceddu⁸, Chen Liu³, Michael Ruemelin⁹, Amy Sharkey⁹, Lachlan McDowell³, Dean Wilkinson¹⁰, Albert Tiong³, Danny Rischin^{11

12}

Affiliations

¹ Genesiscare Radiation Oncology Department, St Vincents Hospital, Melbourne, VIC, Australia.
² Department Medicine, University of Melbourne, Melbourne, VIC, Australia.
³ Department Radiation Oncology, Peter MacCallum Cancer Center, Melbourne, VIC, Australia.
⁴ Department Radiation Quality Assurance, Trans-Tasman Radiation Oncology Group (TROG), Newcastle, NSW, Australia.
⁵ Department Radiation Oncology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
⁶ Faculty Medicine, University of Queensland, Brisbane, QLD, Australia.
⁷ Department Radiation Oncology, Calvary Mater Hospital and University Newcastle, Newcastle, NSW, Australia.
⁸ Department Radiation Oncology, Princess Alexander Hospital, Brisbane, QLD, Australia.
⁹ Department Radiation Therapy, Peter MacCallum Cancer Center, Melbourne, VIC, Australia.
¹⁰ Department Radiation Therapy, Illawarra Cancer Care Centre, Wollongong, NSW, Australia.
¹¹ Department Medical Oncology, Peter MacCallum Cancer Center, Melbourne, VIC, Australia.
¹² Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.

PMID: 38375205
PMCID: PMC10875123
DOI: 10.3389/fonc.2023.1333098

Radiotherapy quality assurance in the TROG 12.01 randomised trial and its impact on loco-regional failure

June Corry et al. Front Oncol. 2024.

. 2024 Feb 5:13:1333098.

doi: 10.3389/fonc.2023.1333098. eCollection 2023.

Authors

Affiliations

¹ Genesiscare Radiation Oncology Department, St Vincents Hospital, Melbourne, VIC, Australia.
² Department Medicine, University of Melbourne, Melbourne, VIC, Australia.
³ Department Radiation Oncology, Peter MacCallum Cancer Center, Melbourne, VIC, Australia.
⁴ Department Radiation Quality Assurance, Trans-Tasman Radiation Oncology Group (TROG), Newcastle, NSW, Australia.
⁵ Department Radiation Oncology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
⁶ Faculty Medicine, University of Queensland, Brisbane, QLD, Australia.
⁷ Department Radiation Oncology, Calvary Mater Hospital and University Newcastle, Newcastle, NSW, Australia.
⁸ Department Radiation Oncology, Princess Alexander Hospital, Brisbane, QLD, Australia.
⁹ Department Radiation Therapy, Peter MacCallum Cancer Center, Melbourne, VIC, Australia.
¹⁰ Department Radiation Therapy, Illawarra Cancer Care Centre, Wollongong, NSW, Australia.
¹¹ Department Medical Oncology, Peter MacCallum Cancer Center, Melbourne, VIC, Australia.
¹² Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.

PMID: 38375205
PMCID: PMC10875123
DOI: 10.3389/fonc.2023.1333098

Abstract

Introduction: There is no consensus as to what specifically constitutes head and neck cancer radiotherapy quality assurance (HNC RT QA). The aims of this study are to (1) describe the RT QA processes used in the TROG 12.01 study, (2) review the RT QA processes undertaken for all patients with loco-regional failure (LRF), and (3) provide prospective data to propose a consensus statement regarding the minimal components and optimal timing of HNC RT QA.

Materials and methods: All patients undergoing RT QA in the original TROG 12.01 study were included in this substudy. All participating sites completed IMRT credentialling and a clinical benchmark case. Real-time (pre-treatment) RT QA was performed for the first patient of each treating radiation oncologist, and for one in five of subsequent patients. Protocol violations were deemed major if they related to contour and/or dose of gross tumour volume (GTV), high dose planning target volume (PTVhd), or critical organs of risk (spinal cord, mandible, and brachial plexus).

Results: Thirty HNROs from 15 institutions accrued 182 patients. There were 28 clinical benchmark cases, 27 pre-treatment RT QA cases, and 38 post-treatment cases. Comprehensive RT QA was performed in 65/182 (36%) treated patients. Major protocol violations were found in 5/28 benchmark cases, 5/27 pre-treatment cases, and 6/38 post-treatment cases. An independent review of all nine LRF cases showed major protocol violations in four of nine cases.

Conclusion: Only pre-treatment RT QA can improve patient outcomes. The minimal components of RT QA in HNC are GTVs, PTVhd, and critical organs at risk. What constitutes major dosimetric violations needs to be harmonised.

Keywords: head and neck (H&N) cancer; human papilloma virus - HPV; intensity modulated radiotherapy (IMRT); quality assurance; radiotherapy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

**Figure 2**
On-Trial Radiotherapy Quality Assurance.

**Figure 3**
Cases of Major Protocol violations and loco-regional failure.

See this image and copyright information in PMC

References

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Radiotherapy quality assurance in the TROG 12.01 randomised trial and its impact on loco-regional failure

Affiliations

Radiotherapy quality assurance in the TROG 12.01 randomised trial and its impact on loco-regional failure

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources