Redesigning Radiotherapy Quality Assurance: Opportunities to Develop an Efficient, Evidence-Based System to Support Clinical Trials鈥擱eport of the National聽Cancer Institute Work Group on Radiotherapy Quality Assurance

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• 作者：Justin E. Bekelman ; M.D.^&lowast ; ; ^{bekelman@uphs.upenn.edu} ; James A. Deye ; Ph.D.^&dagger ; ; Bhadrasain Vikram ; M.D.^&dagger ; ; Soren M. Bentzen ; Ph.D.^&Dagger ; ; Deborah Bruner ; Ph.D.^&lowast ; ; Walter J. Curran Jr. ; M.D.^§ ; ; James Dignam ; Ph.D.^¶ ; ; Jason A. Efstathiou ; M.D. ; D.Phil.^鈥?/sup> ; T.J. FitzGerald ; M.D.^# ; Coen Hurkmans ; Ph.D.^&lowast ; &lowast ; ; Geoffrey S. Ibbott ; Ph.D.^&dagger ; &dagger ; ; J. Jack Lee ; Ph.D.^&dagger ; &dagger ; ; Thomas E. Merchant ; M.D.^&Dagger ; &Dagger ; ; Jeff Michalski ; M.D.^§ ; § ; ; Jatinder R. Palta ; Ph.D.^¶ ; ¶ ; ; Richard Simon ; D.Sc.^{鈥栤€?/sup>} ; Randal K. Ten Haken ; Ph.D.^## ; Robert Timmerman ; M.D.^&lowast ; &lowast ; &lowast ; ; Sean Tunis ; M.D.^&dagger ; &dagger ; &dagger ; ; C. Norman Coleman ; M.D.^&dagger ; ; James Purdy ; Ph.D.^&Dagger ; &Dagger ; &Dagger ;
• 关键词：Clinical trial design ; Credentialing ; Radiotherapy ; Quality assurance
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2012
• 期刊代码：136_03603016
• 类别：med
• 出版时间：1 July, 2012
• 卷：83
• 期：3
• 页码：782-790
• 文件大小：192 K

摘要

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Purpose

In the context of national calls for reorganizing cancer clinical trials, the National Cancer Institute sponsored a 2-day workshop to examine challenges and opportunities for optimizing radiotherapy quality assurance (QA) in clinical trial design.

Methods and Materials

Participants reviewed the current processes of clinical trial QA and noted the QA challenges presented by advanced technologies. The lessons learned from the radiotherapy QA programs of recent trials were discussed in detail. Four potential opportunities for optimizing radiotherapy QA were explored, including the use of normal tissue toxicity and tumor control metrics, biomarkers of radiation toxicity, new radiotherapy modalities such as proton beam therapy, and the international harmonization of clinical trial QA.

Results

Four recommendations were made: (1) to develop a tiered (and more efficient) system for radiotherapy QA and tailor the intensity of QA to the clinical trial objectives (tiers include general credentialing, trial-specific credentialing, and individual case review); (2) to establish a case QA repository; (3) to develop an evidence base for clinical trial QA and introduce innovative prospective trial designs to evaluate radiotherapy QA in clinical trials; and (4) to explore the feasibility of consolidating clinical trial QA in the United States.

Conclusion

Radiotherapy QA can affect clinical trial accrual, cost, outcomes, and generalizability. To achieve maximum benefit, QA programs must become more efficient and evidence-based.