Quality assurance of the EORTC radiotherapy trial 22931 for head and neck carcinomas: the dummy run.

PURPOSE

A dummy run was organized to test the compliance of participating centres with the guidelines of EORTC protocol 22931, which compares high dose radiotherapy with concomitant radiochemotherapy in a postoperative setting for patients presenting with locally advanced head and neck carcinomas.

METHODS

In a first step the participants (seven centres, six replies) were asked to define the planning target volume (PTV) in a given patient on the basis of clinical, surgical and radiological (CT-images) data-sets and according to the protocol guidelines. In a second phase a series of CT-reconstructed slices with on- and off-axis PTV outlines were sent to 11 centres (10 replies), which were asked to plan a treatment following the recommendations made in the frame of the trial.

RESULTS

The first step of this dummy run emphasized wide intercentre variations in PTV extensions. This fact raises the question of the reproducibility when pooling patients in multicentric trials. The second step indicated a large variability in the field arrangements which was left to the discretion of the investigators. Only three out of 10 of the institutions followed the ICRU 50 recommendations for dose reporting. Moreover, protocol requirements were not met for dose distribution homogeneity in any centre.

CONCLUSIONS

In order to reduce intercentre treatment heterogeneities, several actions have been taken by the EORTC Radiotherapy Group, e.g. amendments have been brought to protocol 22931 regarding a better definition of clinical and planning target volumes. Furthermore, a stricter application of the ICRU 50 recommendations for dose reporting has been sought.