Does quality of radiation therapy predict outcomes of multicenter cooperative group trials? A literature review

UMMS Affiliation

Department of Radiation Oncology



Document Type


Medical Subject Headings

Breast Neoplasms; Clinical Trials as Topic; Disease-Free Survival; Female; Head and Neck Neoplasms; Hematologic Neoplasms; Humans; Lung Neoplasms; Male; Multicenter Studies as Topic; Neoplasms; *Outcome Assessment (Health Care); Pancreatic Neoplasms; Psychometrics; Quality Assurance, Health Care; Radiotherapy


Neoplasms | Oncology | Radiology


Central review of radiation therapy (RT) delivery within multicenter clinical trials was initiated in the early 1970s in the United States. Early quality assurance publications often focused on metrics related to process, logistics, and timing. Our objective was to review the available evidence supporting correlation of RT quality with clinical outcomes within cooperative group trials. A MEDLINE search was performed to identify multicenter studies that described central subjective assessment of RT protocol compliance (quality). Data abstracted included method of central review, definition of deviations, and clinical outcomes. Seventeen multicenter studies (1980-2012) were identified, plus one Patterns of Care Study. Disease sites were hematologic, head and neck, lung, breast, and pancreas. Between 0 and 97% of treatment plans received an overall grade of acceptable. In 7 trials, failure rates were significantly higher after inadequate versus adequate RT. Five of 9 and 2 of 5 trials reported significantly worse overall and progression-free survival after poor-quality RT, respectively. One reported a significant correlation, and 2 reported nonsignificant trends toward increased toxicity with noncompliant RT. Although more data are required, protocol-compliant RT may decrease failure rates and increase overall survival and likely contributes to the ability of collected data to answer the central trial question.

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Citation: Fairchild A, Straube W, Laurie F, Followill D. Does quality of radiation therapy predict outcomes of multicenter cooperative group trials? A literature review. Int J Radiat Oncol Biol Phys. 2013 Oct 1;87(2):246-60. doi: 10.1016/j.ijrobp.2013.03.036. Epub 2013 May 15. Review. PubMed PMID: 23683829; PubMed Central PMCID: PMC3749289. Link to article on publisher's site


This study was supported in part by Grant CA-29511 from the National Cancer Institute for the IROC Rhode Island (QARC), a quality assurance vehicle and data management service for diagnostic imaging and radiation oncology for the National Cancer Institute Clinical Trials Program. QARC is a research program within the University of Massachusetts Medical School led by Dr. Thomas (TJ) FitzGerald of the Department of Radiation Oncology.

Related Resources

Link to Article in PubMed