Pretreatment central quality control for craniospinal irradiation in non-metastatic medulloblastoma
Stefan Dietzsch, Annett Braesigk, Clemens Seidel, Julia Remmele, Ralf Kitzing, Tina Schlender, Martin Mynarek, Dirk Geismar, Karolina Jabłońska, Rudolf Schwarz, Montserrat Pazos, M. Walser, Silke Frick, Kristin Gurtner, Christiane Matuschek, Semi Harrabi, Albrecht Glück, Victor Lewitzki, Karin Dieckmann, Martin Benesch, Nicolas U. Gerber, Stefan Rutkowski, Beate Timmermann, Rolf‐Dieter Kortmann
Abstract
PURPOSE: Several studies have demonstrated the negative impact of radiotherapy protocol deviations on tumor control in medulloblastoma. In the SIOP PNET5 MB trial, a pretreatment radiotherapy quality control (RT-QC) program was introduced. A first analysis for patients enrolled in Germany, Switzerland and Austria with focus on types of deviations in the initial plan proposals and review criteria for modern radiation technologies was performed. METHODS AND PATIENTS: Sixty-nine craniospinal irradiation (CSI) plans were available for detailed analyses. RT-QC was performed according to protocol definitions on dose uniformity. Because of the lack of definitions for high-precision 3D conformal radiotherapy within the protocol, additional criteria for RT-QC on delineation and coverage of clinical target volume (CTV) and planning target volume (PTV) were defined and evaluated. RESULTS: Target volume (CTV/PTV) deviations occurred in 49.3% of initial CSI plan proposals (33.3% minor, 15.9% major). Dose uniformity deviations were less frequent (43.5%). Modification of the RT plan was recommended in 43.5% of CSI plans. Unacceptable RT plans were predominantly related to incorrect target delineation rather than dose uniformity. Unacceptable plans were negatively correlated to the number of enrolled patients per institution with a cutoff of 5 patients (p = 0.001). CONCLUSION: This prospective pretreatment individual case review study revealed a high rate of deviations and emphasizes the strong need of pretreatment RT-QC in clinical trials for medulloblastoma. Furthermore, the experiences point out the necessity of new RT-QC criteria for high-precision CSI techniques.