Abstract
IntroductionThe current phase III EORTC 1420 Best-of trial (NCT02984410) compares the swallowing function after transoral surgery versus intensity modulated radiotherapy (RT) in patients with early-stage carcinoma of the oropharynx, supraglottis and hypopharynx. We report the analysis of the Benchmark Case (BC) procedures before patient recruitment with special attention to dysphagia/aspiration related structures (DARS).Materials and methodsSubmitted RT volumes and plans from participating centers were analyzed and compared against the gold-standard expert delineations and dose distributions. Descriptive analysis of protocol deviations was conducted. Mean Sorensen-Dice similarity index (mDSI) and Hausdorff distance (mHD) were applied to evaluate the inter-observer variability (IOV).Results65% (23/35) of the institutions needed more than one submission to achieve Quality assurance (RTQA) clearance. OAR volume delineations were the cause for rejection in 53% (40/76) of cases. IOV could be improved in 5 out of 12 OARs by more than 10 mm after resubmission (mHD). Despite this, final IOV for critical OARs in delineation remained significant among DARS by choosing an aleatory threshold of 0.7 (mDSI) and 15 mm (mHD).ConclusionsThis is to our knowledge the largest BC analysis among Head and neck RTQA programs performed in the framework of a prospective trial. Benchmarking identified non-common OARs and target delineations errors as the main source of deviations and IOV could be reduced in a significant number of cases after this process. Due to the substantial resources involved with benchmarking, future benchmark analyses should assess fully the impact on patients’ clinical outcome.
Highlights
The current phase III EORTC 1420 Best-of trial (NCT02984410) compares the swallowing function after transoral surgery versus intensity modulated radiotherapy (RT) in patients with early-stage carcinoma of the orophar‐ ynx, supraglottis and hypopharynx
Final inter-observer variability (IOV) for critical Organs at risk (OAR) in delineation remained significant among dysphagia/aspiration related structures (DARS) by choosing an aleatory threshold of 0.7 and 15 mm. This is to our knowledge the largest Benchmark Case (BC) analysis among Head and neck RTQA programs performed in the framework of a prospective trial
Benchmarking identified non-common OARs and target delineations errors as the main source of deviations and IOV could be reduced in a significant number of cases after this process
Summary
The current phase III EORTC 1420 Best-of trial (NCT02984410) compares the swallowing function after transoral surgery versus intensity modulated radiotherapy (RT) in patients with early-stage carcinoma of the orophar‐ ynx, supraglottis and hypopharynx. Due to the emergence of HPV related oropharyngeal cancer and the increase in survival over the past decades, quality of life and in particular preservation of swallowing function becomes of paramount importance [1, 2]. Novel strategies such as intensity modulated radiation therapy (IMRT) with defined constraints to dysphagia/aspiration related structures (DARS) and trans-oral surgery have been developed to provide better functional outcome whilst preserving treatment efficacy [3, 4]. The primary endpoint is the patient reported swallowing function over the first year evaluated by the MD Anderson Dysphagia Inventory [7]
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