The potential impact of treatment variations on the results of radiotherapy of the internal mammary lymph node chain: a quality-assurance report on the dummy run of EORTC Phase III randomized trial 22922/10925 in Stage I--III breast cancer(1).
OBJECTIVE
To present the results of the dummy run of the European Organization for Research and Treatment of Cancer (EORTC) trial investigating the role of adjuvant internal mammary and medial supraclavicular (IM-MS) irradiation in Stage I--III breast cancer.


METHODS
All participating institutions were asked to produce a treatment plan without (Arm 1) and with (Arm 2) simultaneous IM-MS irradiation of 1 patient after mastectomy and of 1 patient after lumpectomy. Thirty-two dummy runs have been evaluated for compliance to protocol guidelines, with respect to treatment technique and dose prescription.


RESULTS
A number of more or less important deviations in treatment setup and prescription have been found. The dose in the IM-MS region deviated significantly from the prescribed dose in 10% of the cases for Arm 1, and in 21% for Arm 2. Assuming a true 5% 10-year survival benefit from optimal IM-MS irradiation, an increase of only 3.8% will be found due to this suboptimal dose distribution.


CONCLUSIONS
In the dummy run, a number of potential systematic protocol deviations that might lead to false-negative results were detected. By providing recommendations to the participating institutions, we expect to improve the interinstitutional consistency and to promote a high quality irradiation in all institutions participating in the trial.
Poortmans
P M
PM
Department of Radiotherapy, Dr. Bernard Verbeeten Instituut, Tilburg, The Netherlands. poortmans.ph@bvi.nl
Venselaar
J L
JL
Struikmans
H
H
Hurkmans
C W
CW
Davis
J B
JB
Huyskens
D
D
van Tienhoven
G
G
Vlaun
V
V
Lagendijk
J J
JJ
Mijnheer
B J
BJ
De Winter
K A
KA
Van der Hulst
M H
MH
Van den Bogaert
W F
WF
D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D015182:Lymphatic Irradiation / Q000592:standards*; D008408:Mastectomy; D015412:Mastectomy, Segmental; D009367:Neoplasm Staging; D055585:Physical Phenomena; D010825:Physics; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000592:standards