Quality assurance of radiotherapy in the ongoing EORTC 22042-26042 trial for atypical and malignant meningioma: results from the dummy runs and prospective individual case Reviews.
BACKGROUND
The ongoing EORTC 22042-26042 trial evaluates the efficacy of high-dose radiotherapy (RT) in atypical/malignant meningioma. The results of the Dummy Run (DR) and prospective Individual Case Review (ICR) were analyzed in this Quality Assurance (QA) study.


METHODS
Institutions were requested to submit a protocol compliant treatment plan for the DR and ICR, respectively. DR-plans (n=12) and ICR-plans (n=50) were uploaded to the Image-Guided Therapy QA Center of Advanced Technology Consortium server (http://atc.wustl.edu/) and were assessed prospectively.


RESULTS
Major deviations were observed in 25% (n=3) of DR-plans while no minor deviations were observed. Major and minor deviations were observed in 22% (n=11) and 10% (n=5) of the ICR-plans, respectively. Eighteen% of ICRs could not be analyzed prospectively, as a result of corrupted or late data submission. CTV to PTV margins were respected in all cases. Deviations were negatively associated with the number of submitted cases per institution (p=0.0013), with a cutoff of 5 patients per institutions. No association (p=0.12) was observed between DR and ICR results, suggesting that DR's results did not predict for an improved QA process in accrued brain tumor patients.


CONCLUSIONS
A substantial number of protocol deviations were observed in this prospective QA study. The number of cases accrued per institution was a significant determinant for protocol deviation. These data suggest that successful DR is not a guarantee for protocol compliance for accrued patients. Prospective ICRs should be performed to prevent protocol deviations.
Department of Radiation Oncology, Ankara Oncology Hospital, Ankara, Turkey.
Mehtap
M
Coskun
William
W
Straube
Coen W
CW
Hurkmans
Christos
C
Melidis
Patricia F
PF
de Haan
Salvador
S
Villà
Sandra
S
Collette
Damien C
DC
Weber
D002985:Clinical Protocols / Q000592:standards*; D006801:Humans; D008577:Meningeal Neoplasms; D008579:Meningioma / Q000532:radiotherapy*; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D018787:Radiation Oncology / Q000592:standards*; D011880:Radiotherapy Planning, Computer-Assisted / Q000145:classification / Q000592:standards*