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

Abstract

BackgroundThe 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.Material/methodsInstitutions 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.ResultsMajor 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.ConclusionsA 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.

Adjuvant postoperative high-dose radiotherapy for atypical and malignant meningioma: A phase-II parallel non-randomized and observation study (EORTC 22042-26042)

“…Interestingly, RTQA of this trial was excellent, with only 4.8% of the reviewed plans being non-protocol compliant. In the present study, RTQA was performed prospectively and each plan had to be uploaded in a secure server and reviewed prior to the initiation of the RT [15], using the same RTQA platform than the US trial [16]. Importantly, 18% of plans could not be prospectively analyzed as result of either corrupted or late data submission.…”

“…The target delineation definitions and dose constraints for organs at risk are detailed in Supplemental Tables 1 and 2. The quality assurance (RTQA) results of this study have been published previously [15]. Treatment after disease progression was left to the discretion of the treating physicians.…”

Radiotherapy quality assurance for the RTOG 0834/EORTC 26053-22054/NCIC CTG CEC.1/CATNON intergroup trial “concurrent and adjuvant temozolomide chemotherapy in newly diagnosed non-1p/19q deleted anaplastic glioma”: Individual case review analysis

“…As mentioned, the high incompliance with the 1 st patient randomized could be explained by the fact that no benchmark case exercise was conducted before patient accrual[21, 22]. However, the impact of benchmarking and prevention of future protocol non-compliance is questionable and there are conflicting results from other publications who address this issue[23].…”

Dose-painting intensity-modulated proton therapy for intermediate- and high-risk meningioma

“…Until the results of the EORTC 22042-26042 and Radiation Therapy Oncology Group 0539 studies [ 3 , 33 ] are available, there is no agreement on what radiation dose level should be prescribed for WHO grade II-III or recurrent meningioma; however, higher doses are believed to be more effective. Several studies examine the benefits of dose escalation – either by increasing the number of fractions with 3-dimensional (3D) conformal photon, photon-proton radiation therapy [ 3 , 11 , 12 ] or by using a sequential boost with photon 3D-conformal radiation therapy/IMRT [ 33 ], IMPT and carbon-ion radiation therapy [ 34 , 35 ]. A few studies demonstrated clinical feasibility of dose escalation combining photon and proton beams [ 10 - 12 ].…”