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A. Price
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MO23 - Radiotherapy II: Lung Toxicity, Target Definition and Quality Assurance (ID 107)
- Event: WCLC 2013
- Type: Mini Oral Abstract Session
- Track: Radiation Oncology + Radiotherapy
- Presentations: 2
- Moderators:M.M. Tin, F. Macbeth
- Coordinates: 10/30/2013, 10:30 - 12:00, Bayside 204 A+B, Level 2
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MO23.04 - Is pre-trial quality assurance (QA) effective? A comparison of pre-trial QA versus ongoing QA for the CONVERT Trial. (ID 1809)
10:50 - 10:55 | Author(s): A. Price
- Abstract
- Presentation
Background
CONVERT is an international randomised phase III trial comparing 45Gy in 30 fractions twice-daily and 66Gy in 33 fractions once-daily (given concurrently with cisplatin/etoposide) for good performance status patients with limited stage small cell lung cancer. A QA programme was set-up to standardise radiotherapy (RT) delivery across all centres.Methods
The pre-trial QA exercise (PQE) involved completion of a questionnaire and treatment planning exercise. Each participating clinician was asked to select a previously treated patient, who fitted the entry criteria for the trial, and provide disease and organs at risk (OAR) outlines and a treatment plan for both arms of the trial. QA guidelines, including an atlas for OAR outlining, were distributed to participating centres. Additionally, at least one RT plan per centre was randomly collected during the trial (ongoing QA exercise-OQE). A comparison was made between the PQE and OQE for each centre, including a review of eligibility criteria, OAR and gross tumour volume (GTV) outlining, expansion to clinical target volume (CTV) and planning target volume (PTV).Results
Twenty nine clinicians from 28 centres who had completed both the pre-trial QA and the ongoing QA were included in the analysis. From the pre-trial questionnaire it was reported that 3 centres were using beam energies of 10MV or more which was not permitted as per protocol. Subsequently the PQE showed that these all used acceptable beam energies. Four clinicians submitted ineligible patients for the PQE and none for the OQE. Twenty five clinicians (86.2%) used the correct GTV to CTV and CTV to PTV expansions for the PQE and OQE. Table 1 shows a comparison of adherence to protocol regarding OAR outlining between the PQE and OQE. Table 1
Organ at risk doses were found to be within the tolerances specified in the trial protocol for both PQE and OQE.Oesophagus outline Spinal canal outline Heart outline Lung-PTV outline PQE-OAR outline as per protocol (n=29) 19 (65.5%) 14 (48.3%) 4 (13.8%) 20 (68.9%) OQE-OAR outline as per protocol (n=29) 21 (72.4%) 18 (62.1%) 8 (27.6%) 20 (68.9%) Conclusion
A PQE improves clinicians’ compliance to trial protocol, and has been found in the OQE to reduce deviations across the participating centres that may confound the results of the study. Despite the fact that consistency of OAR outlining remained an issue in both the PQE and the OQE an overall improvement was seen following the PQE.Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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MO23.05 - Changes in lung radiotherapy techniques during the CONVERT Trial. A survey of participating centres. (ID 1820)
10:45 - 10:50 | Author(s): A. Price
- Abstract
- Presentation
Background
CONVERT is an international randomised phase III trial, comparing 45Gy in 30 fractions twice-daily or 66Gy in 33 fractions once-daily (given concurrently with cisplatin/etoposide) for good performance status patients with limited stage small cell lung cancer. A survey was sent out to 69 clinicians who had randomised patients into the trial with the aim of establishing how radiotherapy techniques for lung cancer have changed over the 5 years since the trial opened.Methods
As part of the pre-trial quality assurance process each centre was asked to complete a facility questionnaire giving details of treatment planning, delivery and verification techniques. Recruitment to the trial began in April 2008 and in January 2013, a further facility questionnaire was sent to centres. The survey was completed using an on-line survey tool.Results
This analysis includes answers from the 34 clinicians who responded to the questionnaire. Changes in treatment planning techniques and verification since the beginning of the trial are summarised in table 1. Table 1 Figure 1 *Note that some centres reported using more than one beam arrangement, beam energy, planning algorithm or treatment verification technique. Out of the 34 clinicians who answered the questionnaire, 14 (41.1%) are currently using 4DCT, 3 (8.8%) are using breathold techniques and 16 (47.1%) are not using any technique to account for respiratory motion for simulation and treatment planning of lung patients. Data on management of respiratory motion were not available in 2008.Conclusion
During the 5 years the CONVERT Trial has been open there have been significant advances in radiotherapy treatment technology. Major changes include the use of Type B treatment planning algorithms and PET CT for planning, IMRT for treatment and CBCT for treatment verification of patients with small cell lung cancer.Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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P3.14 - Poster Session 3 - Mesothelioma (ID 197)
- Event: WCLC 2013
- Type: Poster Session
- Track: Mesothelioma
- Presentations: 1
- Moderators:
- Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
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P3.14-006 - Radiotherapy for the treatment of pain in Malignant Pleural Mesothelioma: A Systematic Review (ID 1586)
09:30 - 09:30 | Author(s): A. Price
- Abstract
Background
To examine the evidence base for radiotherapy in the treatment of pain in malignant pleural mesothelioma.Methods
A systematic search of the Medline (1946-2013), Embase (1974-2013) and Central (The Cochrane Library Issue 9, 2012) databases was performed looking for studies which evaluated the role of radiotherapy for pain relief in people with malignant pleural mesothelioma (MPM). Studies were included if MPM was radiologically or histologically diagnosed, radiotherapy was given with the intent of improving pain and response rates to radiotherapy were reported. Documentation of the dose and fractionation of radiotherapy that was given was required. Finally, the study must have explored the relationship between radiotherapy and pain response. Systematic reviews were ineligible.Results
Nine studies were eligible. There was marked heterogeneity among studies so quantitative synthesis of results was not possible. The most recent study reported a clinical response rate of 54% two weeks after radiotherapy given at a dose of 36 Gray (Gy) in 12 fractions. This was targeted at the area of MPM that was felt to be causing the pain. However, this assessment was performed retrospectively. A radiological response of 43% measured via CT scanning two months after irradiation was also reported in this study. Another study reported a superior response rate (50%) for those treated with a 4 Gy fraction size compared with those treated with a fraction size of less than 4 Gy (39%). However, this was not randomised and reflected a change in policy to treat sites of symptomatic disease only rather than covering the entire volume of disease. A further study suggested a benefit to hemi-thoracic irradiation at a dose of 30 Gy in 10 fractions. However, Cobalt machines were used in this study. Another study suggested no benefit to hemi-thoracic irradiation at a dose of 40 Gy in 20 fractions. However, 27 of the 47 patients in this study had no pain at study baseline. The other studies in this review report varying response rates, primarily reported in a retrospective fashion.Conclusion
There are no high quality data to support the use of radiotherapy for pain management in MPM. Studies focusing on clear pain endpoints, improving target delineation and delivering higher equivalent doses using modern day radiotherapy are needed. Biomarkers which may predict response in a proportion of patients should be sought.
