Critical Impact of Radiotherapy Protocol Compliance and Quality in the Treatment of Advanced Head and Neck Cancer: Results From TROG 02.02
Identifieur interne : 007975 ( Main/Exploration ); précédent : 007974; suivant : 007976Critical Impact of Radiotherapy Protocol Compliance and Quality in the Treatment of Advanced Head and Neck Cancer: Results From TROG 02.02
Auteurs : Lester J. Peters [Australie, Canada, Espagne, États-Unis, Suisse, France] ; Brian O'Sullivan ; Jordi Giralt ; Thomas J. Fitzgerald ; Andy Trotti ; Jacques Bernier ; Jean Bourhis ; Kally Yuen ; Richard Fisher ; Danny RischinSource :
- Journal of clinical oncology [ 0732-183X ] ; 2010.
Descripteurs français
- Pascal (Inist)
English descriptors
- KwdEn :
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 QARCrecommended 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%; ≥ 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% v78%; 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.
Affiliations:
- Australie, Canada, Espagne, France, Suisse, États-Unis
- Catalogne, Victoria (État)
- Barcelone, Melbourne
- Université de Melbourne
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Peters</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Departments of Radiation Oncology and Medical Oncology, and Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, University of Melbourne</s1><s2>Melbourne</s2><s3>AUS</s3></inist:fA14><country>Australie</country><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region><settlement type="city">Melbourne</settlement></placeName><orgName type="university">Université de Melbourne</orgName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Radiation Oncology, Princess Margaret Hospital</s1><s2>Toronto, Ontario</s2><s3>CAN</s3></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, Ontario</wicri:noRegion></affiliation><affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Department of Radiation Oncology, Hospital General Vall d'Hebron</s1><s2>Barcelona</s2><s3>ESP</s3></inist:fA14><country>Espagne</country><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Department of Radiation Oncology, University of Massachusetts Medical Center</s1><s2>North Worcester, MA</s2><s3>USA</s3></inist:fA14><country>États-Unis</country><wicri:noRegion>North Worcester, MA</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Department of Radiation Oncology, H. Lee Moffitt Cancer Center</s1><s2>Tampa, FL</s2><s3>USA</s3></inist:fA14><country>États-Unis</country><wicri:noRegion>Tampa, FL</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>Department of Radiation Oncology, Genolier Swiss Medical Network</s1><s2>Geneva</s2><s3>CHE</s3></inist:fA14><country>Suisse</country><wicri:noRegion>Geneva</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="07"><s1>Department of Radiation Oncology, Institut Gustave Roussy</s1><s2>Villejuif</s2><s3>FRA</s3></inist:fA14><country>France</country><wicri:noRegion>Villejuif</wicri:noRegion><wicri:noRegion>Institut Gustave Roussy</wicri:noRegion><wicri:noRegion>Villejuif</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>Quality Assurance Review Center</s1><s2>Providence, RI</s2><s3>USA</s3></inist:fA14><country>États-Unis</country><wicri:noRegion>Quality Assurance Review Center</wicri:noRegion></affiliation></author><author><name sortKey="O Sullivan, Brian" sort="O Sullivan, Brian" uniqKey="O Sullivan B" first="Brian" last="O'Sullivan">Brian O'Sullivan</name></author><author><name sortKey="Giralt, Jordi" sort="Giralt, Jordi" uniqKey="Giralt J" first="Jordi" last="Giralt">Jordi Giralt</name></author><author><name sortKey="Fitzgerald, Thomas J" sort="Fitzgerald, Thomas J" uniqKey="Fitzgerald T" first="Thomas J." last="Fitzgerald">Thomas J. Fitzgerald</name></author><author><name sortKey="Trotti, Andy" sort="Trotti, Andy" uniqKey="Trotti A" first="Andy" last="Trotti">Andy Trotti</name></author><author><name sortKey="Bernier, Jacques" sort="Bernier, Jacques" uniqKey="Bernier J" first="Jacques" last="Bernier">Jacques Bernier</name></author><author><name sortKey="Bourhis, Jean" sort="Bourhis, Jean" uniqKey="Bourhis J" first="Jean" last="Bourhis">Jean Bourhis</name></author><author><name sortKey="Yuen, Kally" sort="Yuen, Kally" uniqKey="Yuen K" first="Kally" last="Yuen">Kally Yuen</name></author><author><name sortKey="Fisher, Richard" sort="Fisher, Richard" uniqKey="Fisher R" first="Richard" last="Fisher">Richard Fisher</name></author><author><name sortKey="Rischin, Danny" sort="Rischin, Danny" uniqKey="Rischin D" first="Danny" last="Rischin">Danny Rischin</name></author></analytic><series><title level="j" type="main">Journal of clinical oncology</title><title level="j" type="abbreviated">J. clin. oncol.</title><idno type="ISSN">0732-183X</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Journal of clinical oncology</title><title level="j" type="abbreviated">J. clin. oncol.</title><idno type="ISSN">0732-183X</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Advanced stage</term><term>Cancerology</term><term>Compliance</term><term>Head and neck cancer</term><term>Quality</term><term>Radiotherapy</term><term>Treatment</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Radiothérapie</term><term>Traitement</term><term>Observance</term><term>Cancer de la tête et du cou</term><term>Qualité</term><term>Stade avancé</term><term>Cancérologie</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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 QARCrecommended 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%; ≥ 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% v78%; 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.</div></front></TEI><affiliations><list><country><li>Australie</li><li>Canada</li><li>Espagne</li><li>France</li><li>Suisse</li><li>États-Unis</li></country><region><li>Catalogne</li><li>Victoria (État)</li></region><settlement><li>Barcelone</li><li>Melbourne</li></settlement><orgName><li>Université de Melbourne</li></orgName></list><tree><noCountry><name sortKey="Bernier, Jacques" sort="Bernier, Jacques" uniqKey="Bernier J" first="Jacques" last="Bernier">Jacques Bernier</name><name sortKey="Bourhis, Jean" sort="Bourhis, Jean" uniqKey="Bourhis J" first="Jean" last="Bourhis">Jean Bourhis</name><name sortKey="Fisher, Richard" sort="Fisher, Richard" uniqKey="Fisher R" first="Richard" last="Fisher">Richard Fisher</name><name sortKey="Fitzgerald, Thomas J" sort="Fitzgerald, Thomas J" uniqKey="Fitzgerald T" first="Thomas J." last="Fitzgerald">Thomas J. Fitzgerald</name><name sortKey="Giralt, Jordi" sort="Giralt, Jordi" uniqKey="Giralt J" first="Jordi" last="Giralt">Jordi Giralt</name><name sortKey="O Sullivan, Brian" sort="O Sullivan, Brian" uniqKey="O Sullivan B" first="Brian" last="O'Sullivan">Brian O'Sullivan</name><name sortKey="Rischin, Danny" sort="Rischin, Danny" uniqKey="Rischin D" first="Danny" last="Rischin">Danny Rischin</name><name sortKey="Trotti, Andy" sort="Trotti, Andy" uniqKey="Trotti A" first="Andy" last="Trotti">Andy Trotti</name><name sortKey="Yuen, Kally" sort="Yuen, Kally" uniqKey="Yuen K" first="Kally" last="Yuen">Kally Yuen</name></noCountry><country name="Australie"><region name="Victoria (État)"><name sortKey="Peters, Lester J" sort="Peters, Lester J" uniqKey="Peters L" first="Lester J." last="Peters">Lester J. Peters</name></region></country><country name="Canada"><noRegion><name sortKey="Peters, Lester J" sort="Peters, Lester J" uniqKey="Peters L" first="Lester J." last="Peters">Lester J. Peters</name></noRegion></country><country name="Espagne"><region name="Catalogne"><name sortKey="Peters, Lester J" sort="Peters, Lester J" uniqKey="Peters L" first="Lester J." last="Peters">Lester J. Peters</name></region></country><country name="États-Unis"><noRegion><name sortKey="Peters, Lester J" sort="Peters, Lester J" uniqKey="Peters L" first="Lester J." last="Peters">Lester J. Peters</name></noRegion><name sortKey="Peters, Lester J" sort="Peters, Lester J" uniqKey="Peters L" first="Lester J." last="Peters">Lester J. Peters</name><name sortKey="Peters, Lester J" sort="Peters, Lester J" uniqKey="Peters L" first="Lester J." last="Peters">Lester J. Peters</name></country><country name="Suisse"><noRegion><name sortKey="Peters, Lester J" sort="Peters, Lester J" uniqKey="Peters L" first="Lester J." last="Peters">Lester J. Peters</name></noRegion></country><country name="France"><noRegion><name sortKey="Peters, Lester J" sort="Peters, Lester J" uniqKey="Peters L" first="Lester J." last="Peters">Lester J. Peters</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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