title: Radiotherapy quality assurance report from children's oncology group AHOD0031.
abstract: OBJECTIVE
  A phase 3 trial assessing response-based therapy in intermediate-risk Hodgkin lymphoma mandated real-time central review of involved field radiation therapy (IFRT) and imaging records by a centralized review center to maximize protocol compliance. We report the impact of centralized radiation therapy review on protocol compliance.
  
  
  METHODS
  Review of simulation films, port films, and dosimetry records was required before and after treatment. Records were reviewed by study-affiliated or review center-affiliated radiation oncologists. A deviation of 6% to 10% from protocol-specified dose was scored as "minor"; a deviation of >10% was "major." A volume deviation was scored as "minor" if margins were less than specified or "major" if fields transected disease-bearing areas. Interventional review and final compliance review scores were assigned to each radiation therapy case and compared.
  
  
  RESULTS
  Of 1712 patients enrolled, 1173 underwent IFRT at 256 institutions in 7 countries. An interventional review was performed in 88% of patients and a final review in 98%. Overall, minor and major deviations were found in 12% and 6% of patients, respectively. Among the cases for which ≥1 pre-IFRT modification was requested by the Quality Assurance Review Center and subsequently made by the treating institution, 100% were made compliant on final review. By contrast, among the cases for which ≥1 modification was requested but not made by the treating institution, 10% were deemed compliant on final review.
  
  
  CONCLUSIONS
  In a large trial with complex treatment pathways and heterogeneous radiation therapy fields, central review was performed in a large percentage of cases before IFRT and identified frequent potential deviations in a timely manner. When suggested modifications were performed by the institutions, deviations were almost eliminated.
authors: Mount Sinai Medical Center, New York, New York.
authors: Kavita V
authors: KV
authors: Dharmarajan
authors: Vanderbilt University, Nashville, Tennessee.
authors: Debra L
authors: DL
authors: Friedman
authors: Quality Assurance Review Center, Lincoln, Rhode Island.
authors: T J
authors: TJ
authors: FitzGerald
authors: Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors: Kathleen M
authors: KM
authors: McCarten
authors: University of Rochester Medical Center, Rochester, New York.
authors: Louis S
authors: LS
authors: Constine
authors: Children's Oncology Group, Arcadia, California.
authors: Lu
authors: L
authors: Chen
authors: Quality Assurance Review Center, Lincoln, Rhode Island.
authors: Sandy K
authors: SK
authors: Kessel
authors: Quality Assurance Review Center, Lincoln, Rhode Island.
authors: Matt
authors: M
authors: Iandoli
authors: Quality Assurance Review Center, Lincoln, Rhode Island.
authors: Fran
authors: F
authors: Laurie
authors: MD Anderson Cancer Center, Houston, Texas.
authors: Cindy L
authors: CL
authors: Schwartz
authors: Memorial Sloan-Kettering Cancer Center, New York, New York. Electronic address: woldens@mskcc.org.
authors: Suzanne L
authors: SL
authors: Wolden
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001761:Bleomycin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D019983:Guideline Adherence; D006689:Hodgkin Disease / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011241:Prednisone / Q000008:administration & dosage; D011785:Quality Assurance, Health Care; D011859:Radiography; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D001761:Bleomycin; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone