title: Lungtech, a phase II EORTC trial of SBRT for centrally located lung tumours - a clinical physics perspective.
abstract: BACKGROUND
  The EORTC has launched a phase II trial to assess safety and efficacy of SBRT for centrally located NSCLC: The EORTC 22113-08113-Lungtech trial. Due to neighbouring critical structures, these tumours remain challenging to treat. To guarantee accordance to protocol and treatment safety, an RTQA procedure has been implemented within the frame of the EORTC RTQA levels. These levels are here expanded to include innovative tools beyond protocol compliance verification: the actual dose delivered to each patient will be estimated and linked to trial outcomes to enable better understanding of dose related response and toxicity.
  
  
  METHODS
  For trial participation, institutions must provide a completed facility questionnaire and beam output audit results. To insure ability to comply with protocol specifications a benchmark case is sent to all centres. After approval, institutions are allowed to recruit patients. Nonetheless, each treatment plan will be prospectively reviewed insuring trial compliance consistency over time. As new features, patient's CBCT images and applied positioning corrections will be saved for dose recalculation on patient's daily geometry. To assess RTQA along the treatment chain, institutions will be visited once during the time of the trial. Over the course of this visit, end-to-end tests will be performed using the 008ACIRS-breathing platform with two separate bodies. The first body carries EBT3 films and an ionization chamber. The other body newly developed for PET- CT evaluation is fillable with a solution of high activity. 3D or 4D PET-CT and 4D-CT scanning techniques will be evaluated to assess the impact of motion artefacts on target volume accuracy. Finally, a dosimetric evaluation in static and dynamic conditions will be performed.
  
  
  CONCLUSIONS
  Previous data on mediastinal toxicity are scarce and source of cautiousness for setting-up SBRT treatments for centrally located NSCLC. Thanks to the combination of documented patient related outcomes and CBCT based dose recalculation we expect to provide improved models for dose response and dose related toxicity.
  
  
  CONCLUSIONS
  We have developed a comprehensive RTQA model for trials involving modern radiotherapy. These procedures could also serve as examples of extended RTQA for future radiotherapy trials involving quantitative use of PET and tumour motion.
authors.affiliation: Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands. marie.lambrecht@catharinaziekenhuis.nl.
authors.forename: Marie
authors.initials: M
authors.lastname: Lambrecht
authors.affiliation: EORTC Headquarters, Brussels, Belgium. melichristos@hotmail.com.
authors.forename: Christos
authors.initials: C
authors.lastname: Melidis
authors.affiliation: Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. jj.sonke@nki.nl.
authors.forename: Jan-Jakob
authors.initials: JJ
authors.lastname: Sonke
authors.affiliation: Department of Radiation Oncology, University Medical Center, Freiburg, Germany. Sonja.adebahr@uniklinik-freiburg.de.|German Cancer Consortium (DKTK), partner site Freiburg, Germany. Sonja.adebahr@uniklinik-freiburg.de.
authors.forename: Sonja
authors.initials: S
authors.lastname: Adebahr
authors.affiliation: Department of Nuclear Medicine VUmc, Amsterdam, The Netherlands. r.boellaard@vumc.nl.
authors.forename: Ronald
authors.initials: R
authors.lastname: Boellaard
authors.affiliation: Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. m.verheij@nki.nl.
authors.forename: Marcel
authors.initials: M
authors.lastname: Verheij
authors.affiliation: Department of Radiation Oncology, University of Zurich, Zurich, Switzerland. Matthias.Guckenberger@usz.ch.
authors.forename: Matthias
authors.initials: M
authors.lastname: Guckenberger
authors.affiliation: Department of Radiation Oncology, University Medical Center, Freiburg, Germany. Ursula.nestle@uniklinik-freiburg.de.|German Cancer Consortium (DKTK), partner site Freiburg, Germany. Ursula.nestle@uniklinik-freiburg.de.
authors.forename: Ursula
authors.initials: U
authors.lastname: Nestle
authors.affiliation: Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands. coen.hurkmans@catharinaziekenhuis.nl.
authors.forename: Coen
authors.initials: C
authors.lastname: Hurkmans
mesh_terms: D019985:Benchmarking; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy*; D003625:Data Collection; D004307:Dose-Response Relationship, Radiation; D005060:Europe; D056973:Four-Dimensional Computed Tomography; D019983:Guideline Adherence; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy*; D009038:Motion; D061214:Patient Safety; D019047:Phantoms, Imaging; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D011874:Radiometry / Q000379:methods; D016634:Radiosurgery / Q000379:methods*; D011878:Radiotherapy / Q000009:adverse effects*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome