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Benchmark Credentialing Results for NRG-BR001: The First National Cancer Institute-Sponsored Trial of Stereotactic Body Radiation Therapy for Multiple Metastases.

Publication ,  Journal Article
Al-Hallaq, HA; Chmura, SJ; Salama, JK; Lowenstein, JR; McNulty, S; Galvin, JM; Followill, DS; Robinson, CG; Pisansky, TM; Winter, KA; White, JR ...
Published in: Int J Radiat Oncol Biol Phys
January 1, 2017

PURPOSE: The NRG-BR001 trial is the first National Cancer Institute-sponsored trial to treat multiple (range 2-4) extracranial metastases with stereotactic body radiation therapy. Benchmark credentialing is required to ensure adherence to this complex protocol, in particular, for metastases in close proximity. The present report summarizes the dosimetric results and approval rates. METHODS AND MATERIALS: The benchmark used anonymized data from a patient with bilateral adrenal metastases, separated by <5 cm of normal tissue. Because the planning target volume (PTV) overlaps with organs at risk (OARs), institutions must use the planning priority guidelines to balance PTV coverage (45 Gy in 3 fractions) against OAR sparing. Submitted plans were processed by the Imaging and Radiation Oncology Core and assessed by the protocol co-chairs by comparing the doses to targets, OARs, and conformity metrics using nonparametric tests. RESULTS: Of 63 benchmarks submitted through October 2015, 94% were approved, with 51% approved at the first attempt. Most used volumetric arc therapy (VMAT) (78%), a single plan for both PTVs (90%), and prioritized the PTV over the stomach (75%). The median dose to 95% of the volume was 44.8 ± 1.0 Gy and 44.9 ± 1.0 Gy for the right and left PTV, respectively. The median dose to 0.03 cm3 was 14.2 ± 2.2 Gy to the spinal cord and 46.5 ± 3.1 Gy to the stomach. Plans that spared the stomach significantly reduced the dose to the left PTV and stomach. Conformity metrics were significantly better for single plans that simultaneously treated both PTVs with VMAT, intensity modulated radiation therapy, or 3-dimensional conformal radiation therapy compared with separate plans. No significant differences existed in the dose at 2 cm from the PTVs. CONCLUSIONS: Although most plans used VMAT, the range of conformity and dose falloff was large. The decision to prioritize either OARs or PTV coverage varied considerably, suggesting that the toxicity outcomes in the trial could be affected. Several benchmarks met the dose-volume histogram metrics but produced unacceptable plans owing to low conformity. Dissemination of a frequently-asked-questions document improved the approval rate at the first attempt. Benchmark credentialing was found to be a valuable tool for educating institutions about the protocol requirements.

Duke Scholars

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

January 1, 2017

Volume

97

Issue

1

Start / End Page

155 / 163

Location

United States

Related Subject Headings

  • United States
  • Tumor Burden
  • Stomach
  • Spinal Cord
  • Radiotherapy, Intensity-Modulated
  • Radiotherapy Planning, Computer-Assisted
  • Radiotherapy Dosage
  • Radiosurgery
  • Organs at Risk
  • Oncology & Carcinogenesis
 

Citation

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Al-Hallaq, H. A., Chmura, S. J., Salama, J. K., Lowenstein, J. R., McNulty, S., Galvin, J. M., … Matuszak, M. M. (2017). Benchmark Credentialing Results for NRG-BR001: The First National Cancer Institute-Sponsored Trial of Stereotactic Body Radiation Therapy for Multiple Metastases. Int J Radiat Oncol Biol Phys, 97(1), 155–163. https://doi.org/10.1016/j.ijrobp.2016.09.030
Al-Hallaq, Hania A., Steven J. Chmura, Joseph K. Salama, Jessica R. Lowenstein, Susan McNulty, James M. Galvin, David S. Followill, et al. “Benchmark Credentialing Results for NRG-BR001: The First National Cancer Institute-Sponsored Trial of Stereotactic Body Radiation Therapy for Multiple Metastases.Int J Radiat Oncol Biol Phys 97, no. 1 (January 1, 2017): 155–63. https://doi.org/10.1016/j.ijrobp.2016.09.030.
Al-Hallaq HA, Chmura SJ, Salama JK, Lowenstein JR, McNulty S, Galvin JM, et al. Benchmark Credentialing Results for NRG-BR001: The First National Cancer Institute-Sponsored Trial of Stereotactic Body Radiation Therapy for Multiple Metastases. Int J Radiat Oncol Biol Phys. 2017 Jan 1;97(1):155–63.
Al-Hallaq, Hania A., et al. “Benchmark Credentialing Results for NRG-BR001: The First National Cancer Institute-Sponsored Trial of Stereotactic Body Radiation Therapy for Multiple Metastases.Int J Radiat Oncol Biol Phys, vol. 97, no. 1, Jan. 2017, pp. 155–63. Pubmed, doi:10.1016/j.ijrobp.2016.09.030.
Al-Hallaq HA, Chmura SJ, Salama JK, Lowenstein JR, McNulty S, Galvin JM, Followill DS, Robinson CG, Pisansky TM, Winter KA, White JR, Xiao Y, Matuszak MM. Benchmark Credentialing Results for NRG-BR001: The First National Cancer Institute-Sponsored Trial of Stereotactic Body Radiation Therapy for Multiple Metastases. Int J Radiat Oncol Biol Phys. 2017 Jan 1;97(1):155–163.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

January 1, 2017

Volume

97

Issue

1

Start / End Page

155 / 163

Location

United States

Related Subject Headings

  • United States
  • Tumor Burden
  • Stomach
  • Spinal Cord
  • Radiotherapy, Intensity-Modulated
  • Radiotherapy Planning, Computer-Assisted
  • Radiotherapy Dosage
  • Radiosurgery
  • Organs at Risk
  • Oncology & Carcinogenesis