Critical impact of radiotherapy protocol compliance and quality in the treatment of advanced head and neck cancer: results from TROG 02.02.

Details

Serval ID
serval:BIB_D857950C8DE2
Type
Article: article from journal or magazin.
Collection
Publications
Title
Critical impact of radiotherapy protocol compliance and quality in the treatment of advanced head and neck cancer: results from TROG 02.02.
Journal
Journal of Clinical Oncology
Author(s)
Peters L.J., O'Sullivan B., Giralt J., Fitzgerald T.J., Trotti A., Bernier J., Bourhis J., Yuen K., Fisher R., Rischin D.
ISSN
1527-7755 (Electronic)
ISSN-L
0732-183X
Publication state
Published
Issued date
2010
Peer-reviewed
Oui
Volume
28
Number
18
Pages
2996-3001
Language
english
Notes
Publication types: Journal Article ; Multicenter Study Publication Status: ppublish
Abstract
PURPOSE: To report the impact of radiotherapy quality on outcome in a large international phase III trial evaluating radiotherapy with concurrent cisplatin plus tirapazamine for advanced head and neck cancer.
PATIENTS AND METHODS: The protocol required interventional review of radiotherapy plans by the Quality Assurance Review Center (QARC). All plans and radiotherapy documentation underwent post-treatment review by the Trial Management Committee (TMC) for protocol compliance. Secondary review of noncompliant plans for predicted impact on tumor control was performed. Factors associated with poor protocol compliance were studied, and outcome data were analyzed in relation to protocol compliance and radiotherapy quality.
RESULTS: At TMC review, 25.4% of the patients had noncompliant plans but none in which QARC-recommended changes had been made. At secondary review, 47% of noncompliant plans (12% overall) had deficiencies with a predicted major adverse impact on tumor control. Major deficiencies were unrelated to tumor subsite or to T or N stage (if N+), but were highly correlated with number of patients enrolled at the treatment center (< five patients, 29.8%; > or = 20 patients, 5.4%; P < .001). In patients who received at least 60 Gy, those with major deficiencies in their treatment plans (n = 87) had a markedly inferior outcome compared with those whose treatment was initially protocol compliant (n = 502): -2 years overall survival, 50% v 70%; hazard ratio (HR), 1.99; P < .001; and 2 years freedom from locoregional failure, 54% v 78%; HR, 2.37; P < .001, respectively.
CONCLUSION: These results demonstrate the critical importance of radiotherapy quality on outcome of chemoradiotherapy in head and neck cancer. Centers treating only a few patients are the major source of quality problems.
Keywords
Antineoplastic Combined Chemotherapy Protocols/therapeutic use, Carcinoma, Squamous Cell/drug therapy, Carcinoma, Squamous Cell/pathology, Cisplatin/administration & dosage, Clinical Trials as Topic, Combined Modality Therapy, Follow-Up Studies, Guideline Adherence, Head and Neck Neoplasms/drug therapy, Head and Neck Neoplasms/pathology, Humans, International Agencies, Neoplasm Recurrence, Local/drug therapy, Neoplasm Recurrence, Local/pathology, Neoplasm Staging, Quality Assurance, Health Care, Radiotherapy Dosage, Survival Rate, Treatment Outcome, Triazines/administration & dosage
Pubmed
Web of science
Create date
01/12/2014 17:08
Last modification date
20/08/2019 15:57
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