Quality improvements in prostate radiotherapy: Outcomes and impact of comprehensive quality assurance during the TROG 03.04 ‘RADAR’ trial

Authors

  • Rachel Kearvell,

    1. Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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  • Annette Haworth,

    1. Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
    2. School of Applied Sciences, RMIT University, Melbourne, Victoria, Australia
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  • Martin A Ebert,

    Corresponding author
    1. School of Physics, University of Western Australia, Perth, Western Australia, Australia
    • Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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  • Judy Murray,

    1. Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
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  • Ben Hooton,

    1. Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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  • Sharon Richardson,

    1. Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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  • David J Joseph,

    1. Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
    2. School of Surgery, University of Western Australia, Perth, Western Australia, Australia
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  • David Lamb,

    1. Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
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  • Nigel A Spry,

    1. Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
    2. School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
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  • Gillian Duchesne,

    1. Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
    2. Department of Pathology, University of Melbourne, Melbourne, Victoria, Australia
    3. Departments of Biochemistry and Radiation Sciences, Monash University, Melbourne, Victoria, Australia
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  • James W Denham

    1. School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
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  • R Kearvell PGradDipHlthAdmin; A Haworth PhD; MA Ebert PhD; J Murray PGDipHealSci; B Hooton Grad Dip Comp Sci; S Richardson BSc (Honours) Therapeutic Radiology; DJ Joseph FRANZCR; D Lamb FRANZCR; NA Spry FRANZCR; G Duchesne FRANZCR; JW Denham FRANZCR.
  • Conflict of interest: The TROG 03.04 trial was financially supported by grant funding from Australian and New Zealand government, non-government and institutional sources. Pharmaceutical use and trial logistic support was provided by Abbott Laboratories and Novartis Pharmaceuticals. No financial benefits were paid to trial investigators or listed authors.

Correspondence

Dr Martin A Ebert, Department of Radiation Oncology, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, WA 6009, Australia.

Email: martin.ebert@health.wa.gov.au

Abstract

Introduction

The Trans-Tasman Radiation Oncology Group 03.04 ‘Randomised Androgen Deprivation and Radiotherapy’ multicentre prostate cancer trial examined the optimal duration of androgen deprivation in combination with dose-escalated radiotherapy. Rigorous quality assurance (QA) processes were undertaken to ensure the validity and reliability of the radiation therapy treatment plan data.

Method

QA processes included a planning benchmarking exercise and a periodic audit of target and normal tissue delineation. Centralised electronic review of digital plan data for external-beam radiotherapy was undertaken to detect protocol variations. The impact of clinical factors and feedback to submitting centres during the trial on variation rates was investigated.

Results

Twenty-three centres across Australia and New Zealand recruited 1071 participants to the trial. Treatment plans for 754 participants receiving external-beam treatment alone were reviewed. From these, 1185 minor and 86 major variations were identified, leading to feedback to treating centres to reduce variations for subsequent patients' treatment and plans, suggesting improvement in treatment quality through these QA programs. Participant anatomical factors (delineated clinical target volume and rectal volume) and treatment planning factors (beam energy, beam definition and patient position orientation) were found to significantly impact variation rates. The dummy run demonstrated disagreement in identification of the base of the prostate and the superior extent of the rectum. Feedback from the periodic audit led to a change of practice at five contributing centres.

Conclusion

The application of a suite of complementary QA activities allows the quality of trial data to be optimised and quantified, and can provide a catalyst for reforming treatment practices.

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