title: Quality assurance in the EORTC randomized trial 22922/10925 investigating the role of irradiation of the internal mammary and medial supraclavicular lymph node chain works.
abstract: OBJECTIVE
  A quality assurance (QA) program in conjunction with the EORTC trial investigating the role of adjuvant internal mammary and medial supraclavicular irradiation in stage I-III breast cancer is presented. The results of a dummy run procedure and of an individual case review are compared to each other. The effects of recommendations based on QA procedures on the protocol compliance are evaluated.
  
  
  METHODS
  Prior to protocol activation all participating institutes were asked to produce treatment plans according to the guidelines of the protocol based on manual outlines of an average patient. Thereafter, they were asked to provide data on each of their first six randomized patients.
  
  
  RESULTS
  The dummy run provided a lot of information on specific treatment techniques. In the individual case review, additional patient- and tumor-related data were collected, showing the use of anatomic information for treatment planning. A comparison between both procedures revealed that the individual case reports concurred more accurately with protocol guidelines than the dummy run.
  
  
  CONCLUSIONS
  It was observed that the number of systematic protocol deviations was substantially decreased in trial patients compared to the dummy run case. Therefore, it is concluded that this extensive QA program had a positive effect on the consistency of all institutes participating in the trial.
authors.affiliation: Department of Radiotherapy, Dr. Bernard Verbeeten Instituut, Tilburg, The Netherlands. poortmans.ph@bvi.nl
authors.forename: Philip
authors.initials: P
authors.lastname: Poortmans
authors.forename: Vassilis
authors.initials: V
authors.lastname: Kouloulias
authors.forename: Geertjan
authors.initials: G
authors.lastname: van Tienhoven
authors.forename: Laurence
authors.initials: L
authors.lastname: Collette
authors.forename: Henk
authors.initials: H
authors.lastname: Struikmans
authors.forename: Jack L M
authors.initials: JL
authors.lastname: Venselaar
authors.forename: Walter
authors.initials: W
authors.lastname: Van den Bogaert
authors.forename: J Bernard
authors.initials: JB
authors.lastname: Davis
authors.forename: Philippe
authors.initials: P
authors.lastname: Lambin
mesh_terms: D001943:Breast Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000592:standards; D011880:Radiotherapy Planning, Computer-Assisted / Q000592:standards* / Q000706:statistics & numerical data*; D018714:Radiotherapy, Adjuvant / Q000592:standards* / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome