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Open Access 01-12-2020 | Rectal Cancer | Research

Radiotherapy quality assurance for mesorectum treatment planning within the multi-center phase II STAR-TReC trial: Dutch results

Authors: Roy P. J. van den Ende, Femke P. Peters, Ernst Harderwijk, Heidi Rütten, Liza Bouwmans, Maaike Berbee, Richard A. M. Canters, Georgiana Stoian, Kim Compagner, Tom Rozema, Mariska de Smet, Martijn P. W. Intven, Rob H. N. Tijssen, Jacqueline Theuws, Paul van Haaren, Baukelien van Triest, Dave Eekhout, Corrie A. M. Marijnen, Uulke A. van der Heide, Ellen M. Kerkhof

Published in: Radiation Oncology | Issue 1/2020

Abstract

Background

The STAR-TReC trial is an international multi-center, randomized, phase II study assessing the feasibility of short-course radiotherapy or long-course chemoradiotherapy as an alternative to total mesorectal excision surgery. A new target volume is used for both (chemo)radiotherapy arms which includes only the mesorectum. The treatment planning QA revealed substantial variation in dose to organs at risk (OAR) between centers. Therefore, the aim of this study was to determine the treatment plan variability in terms of dose to OAR and assess the effect of a national study group meeting on the quality and variability of treatment plans for mesorectum-only planning for rectal cancer.

Methods

Eight centers produced 25 × 2 Gy treatment plans for five cases. The OAR were the bowel cavity, bladder and femoral heads. A study group meeting for the participating centers was organized to discuss the planning results. At the meeting, the values of the treatment plan DVH parameters were distributed among centers so that results could be compared. Subsequently, the centers were invited to perform replanning if they considered this to be necessary.

Results

All treatment plans, both initial planning and replanning, fulfilled the target constraints. Dose to OAR varied considerably for the initial planning, especially for dose levels below 20 Gy, indicating that there was room for trade-offs between the defined OAR. Five centers performed replanning for all cases. One center did not perform replanning at all and two centers performed replanning on two and three cases, respectively. On average, replanning reduced the bowel cavity V20Gy by 12.6%, bowel cavity V10Gy by 22.0%, bladder V35Gy by 14.7% and bladder V10Gy by 10.8%. In 26/30 replanned cases the V10Gy of both the bowel cavity and bladder was lower, indicating an overall lower dose to these OAR instead of a different trade-off. In addition, the bowel cavity V10Gy and V20Gy showed more similarity between centers.

Conclusions

Dose to OAR varied considerably between centers, especially for dose levels below 20 Gy. The study group meeting and the distribution of the initial planning results among centers resulted in lower dose to the defined OAR and reduced variability between centers after replanning.

Trial registration

The STAR-TReC trial, ClinicalTrials.gov Identifier: NCT02945566. Registered 26 October 2016, https://clinicaltrials.gov/ct2/show/NCT02945566).

Bentrem DJ, Okabe S, Wong WD, Guillem JG, Weiser MR, Temple LK, et al. T1 adenocarcinoma of the rectum: transanal excision or radical surgery? Ann Surg. 2005;242:472–7; discussion 477-9. https://doi.org/10.1097/01.sla.0000183355.94322.db.CrossRefPubMedPubMedCentral

Van Gijn W, Marijnen CAM, Nagtegaal ID, Kranenbarg EMK, Putter H, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol. 2011;12:575–82. https://doi.org/10.1016/S1470-2045(11)70097-3.CrossRefPubMed

Endreseth BH, Myrvold HE, Romundstad P, Hestvik UE, Bjerkeset T, Wibe A, et al. Transanal excision vs. major surgery for T1 rectal cancer. Dis Colon Rectum. 2005;48:1380–8. https://doi.org/10.1007/s10350-005-0044-6.CrossRefPubMed

Lange MM, Maas CP, Marijnen CAM, Wiggers T, Rutten HJ, Klein Kranenbarg E, et al. Urinary dysfunction after rectal cancer treatment is mainly caused by surgery. Br J Surg. 2008;95:1020–8. https://doi.org/10.1002/bjs.6126.CrossRefPubMed

Hendren SK, O’Connor BI, Liu M, Asano T, Cohen Z, Swallow CJ, et al. Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg. 2005;242:212–23. https://doi.org/10.1097/01.sla.0000171299.43954.ce.CrossRefPubMedPubMedCentral

Peeters KCMJ, van de Velde CJH, Leer JWH, Martijn H, Junggeburt JMC, Kranenbarg EK, et al. Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients - a Dutch colorectal Cancer group study. J Clin Oncol. 2005;23:6199–206. https://doi.org/10.1200/JCO.2005.14.779.CrossRefPubMed

Habr-Gama A, Gama-Rodrigues J, São Julião GP, Proscurshim I, Sabbagh C, Lynn PB, et al. Local recurrence after complete clinical response and watch and wait in rectal cancer after neoadjuvant chemoradiation: impact of salvage therapy on local disease control. Int J Radiat Oncol Biol Phys. 2014;88:822–8. https://doi.org/10.1016/j.ijrobp.2013.12.012.CrossRefPubMed

Glynne-Jones R, Hughes R. Critical appraisal of the “wait and see” approach in rectal cancer for clinical complete responders after chemoradiation. Br J Surg. 2012;99:897–909. https://doi.org/10.1002/bjs.8732.CrossRefPubMed

Marijnen CAM. Organ preservation in rectal cancer: have all questions been answered? Lancet Oncol. 2015;16:e13–22. https://doi.org/10.1016/S1470-2045(14)70398-5.CrossRefPubMed

10.

Stijns RCH, Tromp MSR, Hugen N, de Wilt JHW. Advances in organ preserving strategies in rectal cancer patients. Eur J Surg Oncol. 2018;44:209–19. https://doi.org/10.1016/j.ejso.2017.11.024.CrossRefPubMed

11.

Rombouts AJM, Al-Najami I, Abbott NL, Appelt A, Baatrup G, Bach S, et al. Can we save the rectum by watchful waiting or TransAnal microsurgery following (chemo) radiotherapy versus Total mesorectal excision for early REctal Cancer (STAR-TREC study)?: protocol for a multicentre, randomised feasibility study. BMJ Open. 2017;7:e019474. https://doi.org/10.1136/bmjopen-2017-019474.CrossRefPubMedPubMedCentral

12.

Peters FP, Teo MTW, Appelt AL, Bach S, Baatrup G, de Wilt H, et al. Mesorectal radiotherapy for early stage rectal cancer: a novel target volume. Clin Transl Radiat Oncol. 2020. https://doi.org/10.1016/j.ctro.2020.02.001.CrossRefPubMedPubMedCentral

13.

Appelt AL, Kerkhof EM, Nyvang L, Harderwijk EC, Abbott NL, Teo MTW,et al. Robust dose planning objectives for mesorectal radiotherapy of early stage rectal cancer - a multicentre dose planning study. Tech Innov Patient Support Radiat Oncol. 2019;11:14–21. https://doi.org/10.1016/j.tipsro.2019.09.001.CrossRef

14.

Hussein M, Heijmen BJM, Verellen D, Nisbet A. Automation in intensity modulated radiotherapy treatment planning—a review of recent innovations. Br J Radiol. 2018;91:20180270. https://doi.org/10.1259/bjr.20180270.CrossRefPubMedPubMedCentral

15.

Joye I, Lambrecht M, Jegou D, Hortobágyi E, Scalliet P, Haustermans K. Does a central review platform improve the quality of radiotherapy for rectal cancer? Results of a national quality assurance project. Radiother Oncol. 2014;111:400–5. https://doi.org/10.1016/j.radonc.2014.03.003.CrossRefPubMed

16.

Habraken SJM, Sharfo AWM, Buijsen J, Verbakel WFAR, Haasbeek CJA, Öllers MC, et al. The TRENDY multi-center randomized trial on hepatocellular carcinoma – trial QA including automated treatment planning and benchmark-case results. Radiother Oncol. 2017;125:507–13. https://doi.org/10.1016/j.radonc.2017.09.007.CrossRefPubMed

17.

Fenton PA, Hurkmans C, Gulyban A, Van Der Leer J, Matzinger O, Poortmans P, et al. Quality assurance of the EORTC 22043-30041 trial in post-operative radiotherapy in prostate cancer: results of the dummy run procedure. Radiother Oncol. 2013;107:346–51. https://doi.org/10.1016/j.radonc.2013.04.020.CrossRefPubMed

Title: Radiotherapy quality assurance for mesorectum treatment planning within the multi-center phase II STAR-TReC trial: Dutch results
Authors: Roy P. J. van den Ende
Femke P. Peters
Ernst Harderwijk
Heidi Rütten
Liza Bouwmans
Maaike Berbee
Richard A. M. Canters
Georgiana Stoian
Kim Compagner
Tom Rozema
Mariska de Smet
Martijn P. W. Intven
Rob H. N. Tijssen
Jacqueline Theuws
Paul van Haaren
Baukelien van Triest
Dave Eekhout
Corrie A. M. Marijnen
Uulke A. van der Heide
Ellen M. Kerkhof
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Rectal Cancer
Rectal Cancer
Radiotherapy
Published in: Radiation Oncology / Issue 1/2020
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/s13014-020-01487-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Radiotherapy quality assurance for mesorectum treatment planning within the multi-center phase II STAR-TReC trial: Dutch results

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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