ESTRO 2025 - Abstract Book

S2263

Interdisciplinary – Health economics & health services research

ESTRO 2025

433

Poster Discussion Clinical impact of radiotherapy quality assurance results in contemporary cancer trials: a systematic review and meta-analysis Jane Jomy 1,2 , Radha Sharma 2 , Rachel Lu 2 , David Chen 2 , Philopateer Ataalla 2 , Sanchit Kaushal 2 , Zhihui Amy Liu 3 , Xiang Y Ye 3 , Alysa Fairchild 4 , Alan Nichol 5 , Srinivas Raman 5 1 Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada. 2 Temerty Faculty of Medicine, University of Toronto, Toronto, Canada. 3 Department of Biostatics, Princess Margaret Cancer Centre, Toronto, Canada. 4 Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Canada. 5 Department of Radiation Oncology, BC Cancer, Vancouver, Canada Purpose/Objective: Radiotherapy quality assurance (RTQA) is a critical aspect of clinical trials and is associated with validity and reproducibility of the study findings. We conducted a systematic review and meta-analysis to assess the impact of RTQA results in contemporary clinical trials on patient outcomes. Material/Methods: We searched MEDLINE and CENTRAL from January 1, 2010, to April 4, 2024, for papers that report on the impact of RTQA on patient outcomes in contemporary clinical trials. We conducted random-effects meta-analyses to examine the association of radiotherapy protocol deviations with overall survival, progression free survival, and locoregional recurrence. Results: Of 2,723 citations, 14 publications reporting on 12 clinical trials were included across various disease sites. Of 7,170 total randomized patients across 1,076 institutions in over 25 countries, 5,560 patients had radiotherapy quality data and were included in RTQA analyses. Most included trials (7/12; 58%) conducted exclusively retrospective RTQA after treatment completion. Our meta-analyses found that protocol deviations may be associated with worse overall survival [HR = 1.65 (95% CI: 1.23-2.22; p < 0.001)] (Figure 1) and progression-free survival [HR = 1.79 (95% CI: 1.00-3.21; p = 0.05)] (Figure 2). No significant association was demonstrated between protocol deviations and locoregional recurrence [HR = 1.77 (95% CI: 0.74-4.24; p = 0.20)]. Figure 1. Overall survival among patients with per protocol treatment compared to protocol deviations.

Figure 2. Progression-free survival among patients with per protocol treatment compared to protocol deviations.