Introduction of online adaptive radiotherapy for bladder cancer through a multicentre clinical trial (Trans-Tasman Radiation Oncology Group 10.01)

Abstract

Online adaptive radiotherapy for bladder cancer is a novel radiotherapy technique that was found feasible in a pilot study at a single academic institution. In September 2010 this technique was opened as a multicenter study through the Trans-Tasman Radiation Oncology Group (TROG 10.01 bladder online adaptive radiotherapy treatment). Twelve centers across Australia and New-Zealand registered interest into the trial. A multidisciplinary team of radiation oncologists, radiation therapists and medical physicists represented the trial credentialing and technical support team. To provide timely activation and proper implementation of the adaptive technique the following key areas were addressed at each site: Staff education/training; Practical image guided radiotherapy assessment; provision of help desk and feedback. The trial credentialing process involved face-to-face training and technical problem solving via full day site visits. A dedicated “help-desk” team was developed to provide support for the clinical trial. 26% of the workload occurred at the credentialing period while the remaining 74% came post-center activation. The workload was made up of the following key areas; protocol clarification (36%), technical problems (46%) while staff training was less than 10%. Clinical trial credentialing is important to minimizing trial deviations. It should not only focus on site activation quality assurance but also provide ongoing education and technical support.

Changes in Gross Tumor Volume and Organ Motion Analysis During Neoadjuvant Radiochemotherapy in Patients With Locally Advanced Pancreatic Cancer Using an In-House Analysis System

“…18,19 However, it remains an open question which strategy is the best. Certainly, it will depend on the tumor region, and patient individuality is required.…”

“…17 Also radiation concepts by daily choosing the best plan from a precalculated plan library show promising results. 18,19 However, it remains an open question which strategy is the best. Certainly, it will depend on the tumor region, and patient individuality is required.…”

Quality assuring “Plan of the day” selection in a multicentre adaptive bladder trial: Implementation of a pre-accrual IGRT guidance and assessment module

“…A multi-centre adaptive bladder trial undertaken by the Trans-Tasman Radiation Oncology Group, utilised a series of web-based e-learning modules to improve knowledge of anatomy, treatment imaging and protocol requirements [9]. This web based platform was well received and utilised by many RT staff however a need for pre-accrual practical IGRT experience was expressed by a number of centres [10].…”

Automated replication of cone beam CT‐guided treatments in the Pinnacle3 treatment planning system for adaptive radiotherapy

“…Developing ‘plan of the day’ treatments based on the first week of delivered treatments requires the CBCTs to be aligned with the plan's treatment fields in order to replicate treatment field positioning in the patient after online IGRT. Pham et al describes the different CBCT‐plan registration methods required for seven combinations of multi‐vendor systems in a multi‐centred adaptive radiotherapy bladder cancer trial. The drawback of multi‐vendor radiotherapy systems when attempting to replicate delivered treatments in a TPS is that time‐consuming, manual methods are often required.…”

“…Replicating delivered treatments in Pinnacle 3 with this combination of radiotherapy systems has relied on placement of three fiducial markers (FMs) on the skin at the anterior and lateral setup points prior to CBCT acquisition on the linear accelerator (Linac) . The FMs are used to localise the CBCT acquisition isocentre (CBCT acqiso ) in Pinnacle 3 and then manual translations are applied to register the CBCT acqiso with the treatment plan isocentre (Plan iso ).…”