Radiotherapy trial quality assurance (RT QA) is crucial for ensuring the safe and reliable delivery of radiotherapy trials, and minimizing inter-institutional variations. While previous studies focused on outlining and planning quality assurance (QA), this work explores the process of Image-Guided Radiotherapy (IGRT), and adaptive radiotherapy. This study presents findings from during-accrual QA in the RAIDER trial, evaluating concordance between online and offline plan selections for bladder cancer participants undergoing adaptive radiotherapy. RAIDER had two seamless stages; stage 1 assessed adherence to dose constraints of dose escalated radiotherapy (DART) and stage 2 assessed safety. The RT QA programme was updated from stage 1 to stage 2.
Data from all participants in the adaptive arms (standard dose adaptive radiotherapy (SART) and DART) of the trial was requested (33 centres across the UK, Australia and New Zealand). Data collection spanned September 2015 to December 2022 and included the plans selected online, on Cone-beam computed tomography (CBCT) data. Concordance with the plans selected offline by the independent RT QA central reviewer was evaluated.
Analysable data was received for 72 participants, giving a total of 884 CBCTs. The overall concordance rate was 83% (723/884). From stage 1 to stage 2 the concordance in the plans selected improved from 75% (369/495) to 91% (354/389).
During-accrual IGRT QA positively influenced plan selection concordance, highlighting the need for ongoing support when introducing a new technique. Overall, it contributes to advancing the understanding and implementation of QA measures in adaptive radiotherapy trials.
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2024 Jul 26 [Epub ahead of print]
Amanda Webster, Michael Francis, Hannah Gribble, Clare Griffin, Shaista Hafeez, Vibeke N Hansen, Rebecca Lewis, Helen McNair, Elizabeth Miles, Emma Hall, Robert Huddart, RAIDER Trial Management Group
National Radiotherapy Trials Quality Assurance (RTTQA) Group, University College Hospital (UCLH), 235 Euston Road, London NW1 2BU, United Kingdom., The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, United Kingdom., Clinical Trials and Statistics Unit, The Institute of Cancer Research, 15 Cotswold Road, London SM2 5NG, United Kingdom., The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, United Kingdom; Division of Radiotherapy and Imaging, The Institute of Cancer Research, 15 Cotswold Road, London SM2 5NG, United Kingdom., Copenhagen University Hospital - Rigshospitalet, Department of Oncology, Blegdamsvej 9, 2100 København, Denmark., National Radiotherapy Trials Quality Assurance (RTTQA) Group, Mount Vernon Hospital, Rickmansworth Road, Northwood HA6 2RN, United Kingdom. Electronic address: .