title: Quality assessment of delineation and dose planning of early breast cancer patients included in the randomized Skagen Trial 1.
abstract: To report on a Quality assessment (QA) of Skagen Trial 1, exploring hypofractionation for breast cancer patients with indication for regional nodal radiotherapy.
  
  
  
  Deviations from protocol regarding target volume delineations and dose parameters (Dmin, Dmax, D98%, D95% and D2%) from randomly selected dose plans were assessed. Target volume delineation according to ESTRO guidelines was obtained through atlas based automated segmentation and centrally approved as gold standard (GS). Dice similarity scores (DSC) with original delineations were measured. Dose parameters measured in the two delineations were reported to assess their dosimetric outcome.
  
  
  
  Assessment included 88 plans from 12 centres in 4 countries. DSC showed high agreement in contouring, 99% and 96% of the patients had a complete delineation of target volumes and organs at risk. No deviations in the dosimetric outcome were found in 76% of the patients, 82% and 95% of the patients had successful coverage of breast/chestwall and CTVn_L2-4-interpectoral. Dosimetric outcomes of original delineation and GS were comparable.
  
  
  
  QA showed high protocol compliance and adequate dose coverage in most patients. Inter-observer variability in contouring was low. Dose parameters were in harmony with protocol regardless original or GS segmentation.
authors.affiliation: Department of Oncology, Aarhus University Hospital, Denmark; Department of Radiation Oncology, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Francolini
authors.affiliation: Department of Medical Physics, Aarhus University Hospital, Denmark.
authors.forename: Mette S
authors.initials: MS
authors.lastname: Thomsen
authors.affiliation: Department of Medical Physics, Aarhus University Hospital, Denmark.
authors.forename: Esben S
authors.initials: ES
authors.lastname: Yates
authors.affiliation: Department of Radiation Oncology, Catholic University of Louvain, Belgium.
authors.forename: Carine
authors.initials: C
authors.lastname: Kirkove
authors.affiliation: Department of Medical Physics, Aalborg University Hospital, Denmark.
authors.forename: Ingelise
authors.initials: I
authors.lastname: Jensen
authors.affiliation: Department of Oncology, University Hospital of North Norway, Norway; Immunology Research Group, Institute of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: Egil S
authors.initials: ES
authors.lastname: Blix
authors.affiliation: Department of Oncology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Claus
authors.initials: C
authors.lastname: Kamby
authors.affiliation: Department of Oncology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
authors.forename: Mette H
authors.initials: MH
authors.lastname: Nielsen
authors.affiliation: German Cancer Consortium (DKTK) Dresden and German Cancer Research Center (DKFZ) Heidelberg, Department of Radiation Oncology and OncoRay, University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Germany.
authors.forename: Mechthild
authors.initials: M
authors.lastname: Krause
authors.affiliation: Department of Medical Physics, Hospital of Vejle, Denmark.
authors.forename: Martin
authors.initials: M
authors.lastname: Berg
authors.affiliation: Department of Oncology, Stavanger University Hospital, Norway.
authors.forename: Ingvil
authors.initials: I
authors.lastname: Mjaaland
authors.affiliation: Praxis für Strahlentherapie, Dresden, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schreiber
authors.affiliation: Department of Oncology, Sørlandet Sykehus HF, Kristiansand, Norway.
authors.forename: Unn-Miriam
authors.initials: UM
authors.lastname: Kasti
authors.affiliation: Department of Oncology, Zealand University Hospital, Denmark.
authors.forename: Kristian
authors.initials: K
authors.lastname: Boye
authors.affiliation: Department of Oncology, Aarhus University Hospital, Denmark. Electronic address: birgoffe@rm.dk.
authors.forename: Birgitte V
authors.initials: BV
authors.lastname: Offersen
mesh_terms: D001943:Breast Neoplasms / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D015588:Observer Variation; D058958:Organs at Risk; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000592:standards*
keywords: Delineation; Quality assessment; Skagen Trial 1