Compliance with therapeutic guidelines in Radiation Therapy Oncology Group prospective gastrointestinal clinical trials.
BACKGROUND
This report analyzes the adherence to radiation therapy protocol guidelines in contemporary Radiation Therapy Oncology Group (RTOG) gastrointestinal trials. We aim to provide insight into current standards and compliance of radiation therapy field design and administration.


METHODS
From 1994 to 2006, the Gastrointestinal Cancer Committee of the RTOG initiated and completed 15 phase I-III clinical trials utilizing radiation therapy in the multimodality treatment of gastrointestinal cancers. In each protocol, details for planning and executing radiation therapy were outlined and each protocol contained scoring criteria for these components of radiation therapy, characterized according to per-protocol, variation acceptable and deviation unacceptable. Review of treatment planning and implementation was performed in all studies following therapy completion.


RESULTS
Radiation therapy planning and implementation was reviewed in 2309 of 2312 (99.9%) patients. The mean rate of compliance over all for the 15 protocols was 65% (total of the 2309 analyzed patients). The mean variation acceptable rate was 21% whereas the mean deviation unacceptable rate was 5%. The mean "other" rate (no RT given or incomplete RT due to death, progression or refusal) was 8%. Two of the 15 trials (13%) had deviation unacceptable rates >10%. In four studies incorporating pre-treatment review of radiation therapy planning and treatment, compliance with protocol therapy was enhanced.


CONCLUSIONS
The fidelity of radiation planning and execution detailed in protocol to actual therapy is heterogeneous, with a mean per-protocol rate of 65%. As clinical trials evolve, available technology should permit efficient pre-treatment review processes, thus facilitating compliance to protocol therapy. These analyses should also permit prospective analysis of outcome measures by compliance to therapy.
Duke University, Durham, United States. Christopher.willett@duke.edu
Christopher G
CG
Willett
Jennifer
J
Moughan
Elizabeth
E
O'Meara
James M
JM
Galvin
Christopher H
CH
Crane
Kathryn
K
Winter
Denise
D
Manfredi
Tyvin A
TA
Rich
Rachel
R
Rabinovitch
Robert
R
Lustig
Mitchell
M
Machtay
Walter J
WJ
Curran
D002986:Clinical Trials as Topic; D005770:Gastrointestinal Neoplasms / Q000532:radiotherapy*; D006801:Humans; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D011878:Radiotherapy / Q000592:standards