ESTRO 2023 - Abstract Book

S327

Sunday 14 May 2023

ESTRO 2023

Training needs were highlighted in delineation and interpretation of guidelines for abdominal and pelvic anatomy. Educational contouring workshops have been developed and ongoing support from more experienced centres is in place. Participation in peer review and clinical trials has been recommended. These results highlight the importance and value of a national, QA-driven approach when implementing new techniques nationwide. Only 9% of submissions were approved on first attempt, emphasising that, whilst increasing access to SBRT services for patients is desirable, the process is not straightforward from a quality and safety perspective. Funding and support for a QA program is warranted when expanding SBRT services. OC-0424 ROAM (EORTC 1308) trial – impact of prospective trial reviews on protocol adherence H. Mayles 1 , B. Haylock 2 , M. Jenkinson 3 1 Clatterbridge Cancer Centre, Physics, Liverpool, United Kingdom; 2 Clatterbridge Cancer Centre, Oncology, Liverpool, United Kingdom; 3 The Walton Centre, Neurosurgery, Liverpool, United Kingdom Purpose or Objective ROAM (EORTC 1308) is a multinational randomised controlled trial comparing radiotherapy (RT), 60Gy in 30 daily fractions, to active monitoring after complete surgical resection of atypical meningioma. Robust RTQA protocols improve national and international standards so a rigorous RTQA program was set up for this trial, including prospective reviews for all RT patients, as recommended in a previous meningioma trial (EORTC22042-26042). In this analysis we look at common problems and assess the value of prospective patient reviews. Materials and Methods The UK RTTQA group coordinated the QA and reviewed UK and EORTC centres. An agreement was set up with the Australian QA group (TROG) so that they reviewed the Australian/New Zealand centres and returned all their reports and data to the UK at the end of recruitment. Consensus contouring and planning guidelines were described in the ROAM RT Protocol and were established at trial development and National Neuro-Oncology meetings. The pre-trial QA assessment process included the circulation of Benchmark (BM) Cases, an outlining test case and a different pre-outlined test case for planning. A Dummy Run where centres outlined and planned the cases and uploaded them to the QA servers for QA review ensured that this process was done smoothly. A detailed information package was provided and centres were invited to outlining workshops to see outlining demonstrated and to receive practical feedback in the preferred outlining technique and the pitfalls to avoid during planning. During the trial, Individual Case Reviews (ICR’s) were done prospectively (rapidly within a week) for the contours and plans of every RT patient, except for 2 late submissions. 4 clinicians reviewed the contours and physicists/dosimetrists reviewed the plans. Non-conformities (NCs), classed as major or minor (see Tables 1 and 2), were documented in standardised reports. Resubmissions were done for all plans with Major NC’s. Trial newsletters and centre visits were used to communicate common mistakes. Results 20 UK, 25 EORTC and 11 TROG centres submitted BM cases. BM resubmissions of contours and plans were: UK (1,0), EORTC (2,6) and TROG (1,3) respectively. 11 UK, 12 EORTC and 5 TROG centres treated patients with RT during the trial. RT patient numbers were UK (30), EORTC (26) and TROG (7). In total 25 (40%) patient cases needed resubmitting: 23 (37%) sets of outlines (2 cases twice) and 9 (14%) treatment plans (1 plan twice).

Tables 1 and 2 summarise the findings of the ICR’s.