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doi: https://doi.org/10.4143/crt.2018.415    [Accepted]
Dummy Run of Quality Assurance Program before Prospective Study of Hippocampus-Sparing Whole-Brain Radiotherapy (HS-WBRT) and Simultaneous Integrated Boost (SIB) for Multiple Brain Metastases from Non-Small Cell Lung Cancer: Korean Radiation Oncology Group (KROG) 17-06 Study
Eunah Chung1, Jae Myoung Noh1, Kyu Chan Lee2, Jin Hee Kim3, Wonkyu Chung4, Yang-Gun Suh5, Jung Ae Lee6, Ki Ho Seol7, Hong Gyun Wu8, Yeon Sil Kim9, O Kyu Noh10, Jae Won Park11, Dong Soo Lee12, Jihae Lee13, Young Suk Kim14, Woo-Yoon Park15, Min Kyu Kang16, Sunmi Jo17, Yong Chan Ahn1,18
1Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
2Department of Radiation Oncology, Gachon University Gil Medical Center, Incheon, Korea
3Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Daegu, Korea
4Department of Radiation Oncology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
5Proton Therapy Center, National Cancer Center, Goyang, Korea
6Department of Radiation Oncology, Korea University Guro Hospital, Seoul, Korea
7Department of Radiation Oncology, Catholic University of Daegu School of Medicine, Daegu, Korea
8Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
9Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Korea
10Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
11Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, Korea
12Department of Radiation Oncology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
13Department of Radiation Oncology, Ewha Womans University School of Medicine, Seoul, Korea
14Department of Radiation Oncology, Jeju National University School of Medicine, Jeju, Korea
15Department of Radiation Oncology, Chungbuk National University College of Medicine, Cheongju, Korea
16Department of Radiation Oncology, School of Medicine, Kyungpook National University Daegu, Korea
17Department of Radiation Oncology, Inje University School of Medicine, Busan, Korea
18Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea
Correspondence  Yong Chan Ahn ,Tel: 82-2-3410-2602, Fax: 82-2-6190-5332, Email: ahnyc@skku.edu
Received: July 21, 2018;  Accepted: October 12, 2018.  Published online: October 15, 2018.
*Eunah Chung and Jae Myoung Noh contributed equally to this work.
Lung Cancer Subcommittee of Korean Radiation Oncology Group (KROG) has recently launched a prospective clinical trial (KROG 17-06) of hippocampus-sparing whole brain radiotherapy (HS-WBRT) with simultaneous integrated boost (SIB) in treating multiple brain metastases from non-small cell lung cancer. In order to improve trial quality, dummy run studies among the participating institutions were designed. This work reported the results of two-step dummy run study of the KROG 17-06 protocol.
Materials and Methods
Two steps tested hippocampus contouring variability and radiation therapy planning compliance. In the first step, the variation of the hippocampus delineation was investigated for two representative cases using the Dice similarity coefficients. In the second step, the participating institutions were requested to generate a HS-WBRT with SIB treatment plan for another representative case. The compliance of the treatment plans to the planning protocol was evaluated.
In the first step, the median Dice similarity coefficients of the hippocampus contours for two other dummy run cases changed from 0.669 (range, 0.073 to 0.712) to 0.690 (range, 0.522 to 0.750) and from 0.291 (range, 0.219 to 0.522) to 0.412 (range, 0.264 to 0.598) after providing the hippocampus contouring feedback. In the second step, with providing additional plan priority and extended dose constraints to the target volumes and normal structures, we observed the improved compliance of the treatment plans to the planning protocol.
The dummy run studies demonstrated the notable inter-institutional variability in delineating the hippocampus and treatment plan generation, which could be decreased through feedback from the trial center.
Key words: Hippocampus-sparing whole brain radiotherapy (HS-WBRT), Dummy run, Multi-institutional study, QA program, Non-small cell lung carcinoma
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