B G Wortman1, E Astreinidou2, M S Laman2, E M van der Steen-Banasik3, L C H W Lutgens4, H Westerveld5, F Koppe6, A Slot7, H A van den Berg8, M E Nowee9, S Bijmolt10, T C Stam11, A G Zwanenburg12, J W M Mens13, I M Jürgenliemk-Schulz14, A Snyers15, C M Gillham16, N Weidner17, S Kommoss18, K Vandecasteele19, V Tomancova20, C L Creutzberg2, R A Nout2. 1. Department of Radiation Oncology, Leiden University Medical Centre, The Netherlands. Electronic address: b.g.wortman@lumc.nl. 2. Department of Radiation Oncology, Leiden University Medical Centre, The Netherlands. 3. Radiotherapy Group, Arnhem, The Netherlands. 4. Maastricht Radiation Oncology Clinic, The Netherlands. 5. Department of Radiation Oncology, Amsterdam University Medical Centres, University of Amsterdam, The Netherlands. 6. Department of Radiation Oncology, Institute Verbeeten, Tilburg, The Netherlands. 7. Radiotherapy Institute Friesland, Leeuwarden, The Netherlands. 8. Department of Radiation Oncology, Catharina Hospital Eindhoven, The Netherlands. 9. Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands. 10. Department of Radiation Oncology, University Medical Centre Groningen, The Netherlands. 11. Department of Radiation Oncology, Haaglanden Medical Centre, Leidschendam, The Netherlands. 12. Department of Radiation Oncology, Zwolle, The Netherlands. 13. Department of Radiation Oncology, Erasmus MC-Cancer Institute, Rotterdam, The Netherlands. 14. Department of Radiation Oncology, University Medical Centre Utrecht, The Netherlands. 15. Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands. 16. Department of Radiation Oncology, St Luke's Radiation Oncology Network, Dublin 6, Ireland. 17. Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University, Germany. 18. Department of Women's Health, Tübingen University Hospital, Germany. 19. Department of Radiation Oncology, Ghent University Hospital, Belgium. 20. Department of Clinical Oncology, General Teaching Hospital, First Medical School, Charles University, Prague, Czech Republic.
Abstract
OBJECTIVE: The PORTEC-4a trial investigates molecular-integrated risk profile guided adjuvant treatment for endometrial cancer. The quality assurance programme included a dummy run for vaginal brachytherapy prior to site activation, and annual quality assurance to verify protocol adherence. Aims of this study were to evaluate vaginal brachytherapy quality and protocol adherence. METHODS: For the dummy run, institutes were invited to create a brachytherapy plan on a provided CT-scan with the applicator in situ. For annual quality assurance, institutes provided data of one randomly selected brachytherapy case. A brachytherapy panel reviewed and scored the brachytherapy plans according to a checklist. RESULTS: At the dummy run, 15 out of 21 (71.4%) institutes needed adjustments of delineation or planning. After adjustments, the mean dose at the vaginal apex (protocol: 100%; 7 Gy) decreased from 100.7% to 99.9% and range and standard deviation (SD) narrowed from 83.6-135.1 to 96.4-101.4 and 8.8 to 1.1, respectively. At annual quality assurance, 22 out of 27 (81.5%) cases had no or minor and 5 out of 27 (18.5%) major deviations. Most deviations were related to delineation, mean dose at the vaginal apex (98.0%, 74.7-114.2, SD 7.6) or reference volume length. CONCLUSIONS: Most feedback during the brachytherapy quality assurance procedure of the PORTEC-4a trial was related to delineation, dose at the vaginal apex and the reference volume length. Annual quality assurance is essential to promote protocol compliance, ensuring high quality vaginal brachytherapy in all participating institutes.
OBJECTIVE: The PORTEC-4a trial investigates molecular-integrated risk profile guided adjuvant treatment for endometrial cancer. The quality assurance programme included a dummy run for vaginal brachytherapy prior to site activation, and annual quality assurance to verify protocol adherence. Aims of this study were to evaluate vaginal brachytherapy quality and protocol adherence. METHODS: For the dummy run, institutes were invited to create a brachytherapy plan on a provided CT-scan with the applicator in situ. For annual quality assurance, institutes provided data of one randomly selected brachytherapy case. A brachytherapy panel reviewed and scored the brachytherapy plans according to a checklist. RESULTS: At the dummy run, 15 out of 21 (71.4%) institutes needed adjustments of delineation or planning. After adjustments, the mean dose at the vaginal apex (protocol: 100%; 7 Gy) decreased from 100.7% to 99.9% and range and standard deviation (SD) narrowed from 83.6-135.1 to 96.4-101.4 and 8.8 to 1.1, respectively. At annual quality assurance, 22 out of 27 (81.5%) cases had no or minor and 5 out of 27 (18.5%) major deviations. Most deviations were related to delineation, mean dose at the vaginal apex (98.0%, 74.7-114.2, SD 7.6) or reference volume length. CONCLUSIONS: Most feedback during the brachytherapy quality assurance procedure of the PORTEC-4a trial was related to delineation, dose at the vaginal apex and the reference volume length. Annual quality assurance is essential to promote protocol compliance, ensuring high quality vaginal brachytherapy in all participating institutes.
Authors: Markus Glatzer; Kari Tanderup; Angeles Rovirosa; Lars Fokdal; Claudia Ordeanu; Luca Tagliaferri; Cyrus Chargari; Vratislav Strnad; Johannes Athanasios Dimopoulos; Barbara Šegedin; Rachel Cooper; Esten Søndrol Nakken; Primoz Petric; Elzbieta van der Steen-Banasik; Kristina Lössl; Ina M Jürgenliemk-Schulz; Peter Niehoff; Ruth S Hermansson; Remi A Nout; Paul Martin Putora; Ludwig Plasswilm; Nikolaos Tselis Journal: Cancers (Basel) Date: 2022-02-11 Impact factor: 6.639