Purpose: Involved Node Radiotherapy (INRT) was introduced in the EORTC/LYSA/FIL H10 trial, a large multicenter trial in early stage Hodgkin Lymphoma (HL). The current study aimed to evaluate the quality of INRT in this trial. Methods and materials: A retrospective, descriptive study was initiated to evaluate INRT in a representative sample encompassing approximately 10% of all irradiated patients in the H10 trial. Sampling was stratified by academic group, year of treatment, size of treatment center and treatment arm and it was done proportional to the size of the strata. The sample was completed for all patients with known recurrences to enable future research on relapse pattern. Radiotherapy principle, delineation and coverage of the target volume and applied technique and dose were evaluated using the EORTC Radiotherapy Quality Assurance (RTQA) platform. Each case was reviewed by two reviewers and, in case of disagreement, also by an adjudicator for a consensus evaluation. Results: Data was retrieved for 66 out of 1294 irradiated patients (5.1%). Data collection and analysis were hampered by changes in archiving of diagnostic imaging and treatment planning systems during the running period of the trial, more than anticipated. Review could be performed in 61 patients. The INRT principle was applied in 86.6%. Overall, 88.5% of cases were treated according to protocol. Unacceptable variations were predominately due to geographical misses of the target volume delineations. The rate of unacceptable variations decreased during trial recruitment. Conclusions: The principle of INRT was applied in most of the reviewed patients. Almost 90% of the evaluated patients were treated according to the protocol. The current results should, however, be interpreted with caution because the number of patients evaluated was limited. In future trials, individual case reviews should be done in a prospective fashion. RTQA tailored to the clinical trial objectives is strongly recommended.
A Quality Control Study on Involved Node Radiation Therapy in the European Organisation for Research and Treatment of Cancer/Lymphoma Study Association/Fondazione Italiana Linfomi H10 Trial on Stages I and II Hodgkin Lymphoma: Lessons Learned
Ricardi, Umberto;Levis, Mario;
2023-01-01
Abstract
Purpose: Involved Node Radiotherapy (INRT) was introduced in the EORTC/LYSA/FIL H10 trial, a large multicenter trial in early stage Hodgkin Lymphoma (HL). The current study aimed to evaluate the quality of INRT in this trial. Methods and materials: A retrospective, descriptive study was initiated to evaluate INRT in a representative sample encompassing approximately 10% of all irradiated patients in the H10 trial. Sampling was stratified by academic group, year of treatment, size of treatment center and treatment arm and it was done proportional to the size of the strata. The sample was completed for all patients with known recurrences to enable future research on relapse pattern. Radiotherapy principle, delineation and coverage of the target volume and applied technique and dose were evaluated using the EORTC Radiotherapy Quality Assurance (RTQA) platform. Each case was reviewed by two reviewers and, in case of disagreement, also by an adjudicator for a consensus evaluation. Results: Data was retrieved for 66 out of 1294 irradiated patients (5.1%). Data collection and analysis were hampered by changes in archiving of diagnostic imaging and treatment planning systems during the running period of the trial, more than anticipated. Review could be performed in 61 patients. The INRT principle was applied in 86.6%. Overall, 88.5% of cases were treated according to protocol. Unacceptable variations were predominately due to geographical misses of the target volume delineations. The rate of unacceptable variations decreased during trial recruitment. Conclusions: The principle of INRT was applied in most of the reviewed patients. Almost 90% of the evaluated patients were treated according to the protocol. The current results should, however, be interpreted with caution because the number of patients evaluated was limited. In future trials, individual case reviews should be done in a prospective fashion. RTQA tailored to the clinical trial objectives is strongly recommended.
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