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document
Use of EORTC target definition guidelines for dose-intensified salvage radiation therapy for recurrent prostate cancer : results of the quality assurance program of the randomized trial SAKK 09/10 . PURPOSE Different international target volume delineation guidelines exist and different treatment techniques are available for salvage radiation therapy ( RT ) for recurrent prostate cancer , but less is known regarding their respective applicability in clinical practice . METHODS AND MATERIALS A randomized phase III trial testing 64 Gy vs 70 Gy salvage RT was accompanied by an intense quality assurance program including a site-specific and study-specific questionnaire and a dummy run ( DR ) . Target volume delineation was performed according to the European Organisation for the Research and Treatment of Cancer guidelines , and a DR-based treatment plan was established for 70 Gy . Major and minor protocol deviations were noted , interobserver agreement of delineated target contours was assessed , and dose-volume histogram ( DVH ) parameters of different treatment techniques were compared . RESULTS Thirty European centers participated , 43 % of which were using 3-dimensional conformal RT ( 3D-CRT ) , with the remaining centers using intensity modulated RT ( IMRT ) or volumetric modulated arc technique ( VMAT ) . The first submitted version of the DR contained major deviations in 21 of 30 ( 70 % ) centers , mostly caused by inappropriately defined or lack of prostate bed ( PB ) . All but 5 centers completed the DR successfully with their second submitted version . The interobserver agreement of the PB was moderate and was improved by the DR review , as indicated by an increased κ value ( 0.59 vs 0.55 ) , mean sensitivity ( 0.64 vs 0.58 ) , volume of total agreement ( 3.9 vs 3.3 cm ( 3 ) ) , and decrease in the union volume ( 79.3 vs 84.2 cm ( 3 ) ) . Rectal and bladder wall DVH parameters of IMRT and VMAT vs 3D-CRT plans were not significantly different . CONCLUSIONS The interobserver agreement of PB delineation was moderate but was improved by the DR. Major deviations could be identified for the majority of centers . The DR has improved the acquaintance of the participating centers with the trial protocol .
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Intervention_Pharmacological
64 Gy vs 70 Gy salvage RT
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Intervention_Educational
intense quality assurance program
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Intervention_Physical
dummy run ( DR )
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Intervention_Physical
3-dimensional conformal RT ( 3D-CRT )
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Intervention_Physical
intensity modulated RT ( IMRT )
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Intervention_Physical
volumetric modulated arc technique ( VMAT )
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Participant_Sample-size
Thirty