AUTHOR=Corry June , Moore Alisha , Kenny Liz , Wratten Chris , Fua Tsien , Lin Charles , Porceddu Sandro , Liu Chen , Ruemelin Michael , Sharkey Amy , McDowell Lachlan , Wilkinson Dean , Tiong Albert , Rischin Danny 

TITLE=Radiotherapy quality assurance in the TROG 12.01 randomised trial and its impact on loco-regional failure

JOURNAL=Frontiers in Oncology

VOLUME=Volume 13 - 2023

YEAR=2024

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2023.1333098

DOI=10.3389/fonc.2023.1333098

ISSN=2234-943X

ABSTRACT=Introduction
There is no consensus as what specifically constitutes Head and neck cancer radiotherapy quality assurance (HNC RT QA). The aims of this study are 1) Describe the RT QA processes used in  TROG 12.01 study, 2) review the RT QA processes undertaken for all patients with loco-regional failure (LRF), and 3) provide prospective data to propose a consensus statement regarding the minimal components and optimal timing of HNC RT QA.   

Materials and methods
All patients undergoing RT QA in the original TROG 12.01 study were included in this substudy.
All participating sites completed IMRT credentialling and a clinical benchmark case. Real time (pre-treatment) RT QA was performed for the first patient of each treating radiation oncologist, and for 1 in 5 of subsequent patients. Protocol violations were deemed major if they related to contour and/or dose of gross tumour volume (GTV), high dose planning target volume (PTVhd) or critical organs of risk (spinal cord, mandible, brachial plexus). 

Results
Thirty HNROs from 15 institutions accrued 182 patients. 28 clinical benchmark cases, 27 pre-treatment RT QA, and 38 post treatment. Comprehensive RT QA preformed in 65/182, or 36% of treated patients. Major protocol violations were found in: 5/28 benchmark cases,5/27 pre-treatment cases, and 6/38 post-treatment cases. In the 9 patients with LRF - independent review of all 9 LRF cases showed major protocol violations in 4/9.  

Conclusions
Only pre-treatment RT QA can improve patient outcomes. The minimal components of RT QA in HNC are GTVs, PTVhd and critical organs at risk. What constitutes major dosimetric violations needs to be harmonised.