Journal of the National Cancer Institute Advance Access originally published online on August 26, 2008
JNCI Journal of the National Cancer Institute 2008 100(17):1263-1264; doi:10.1093/jnci/djn236
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© The Author 2008. Published by Oxford University Press.
CORRESPONDENCE |
Re: Intensity-Modulated Radiation Therapy Dose Prescription, Recording, and Delivery: Patterns of Variability Among Institutions and Treatment Planning Systems
Affiliations of authors: Radiation Research Program, National Cancer Institute, Bethesda, MD (JD, BV); Radiation Oncology, University of California Davis Medical Center, Sacramento, CA (JP)
Correspondence to: James Deye, PhD, 6130 Executive Blvd, MSC 7440, EPN 6018, Bethesda, MD 20892 (e-mail: deyej{at}mail.nih.gov).
We read with interest the recent article by Das et al. (1) and the accompanying editorial by Willins and Kachnic (2) concerning the accuracy and concomitant appropriateness of the use of intensity-modulated radiation therapy (IMRT) in multi-institutional studies. On the basis of early publications and clinical experience, the Clinical Radiation Oncology Branch of the National Cancer Institute (NCI) has had similar concerns, which led us to publish guidelines as early as 2002 for the use of IMRT in NCI-sponsored clinical trials (3). These guidelines have been revised twice, and the most recent update in July 2006 addressed the use of IMRT for all anatomic sites, including those involving heterogeneities and target motion (http://www.rtog.org/pdf_document/NCI_IMRT_Guidelines_2006.pdf). Because these guidelines were not cited in either of the above articles, we want to call them to the attention of the Journal’s readership. We also wish to point out that these guidelines have been changed to meet the rapid developments in IMRT technology and issues raised by expanded clinical use, including dose specification. Hence, we fully concur with Das et al. that further study is warranted, along with substantial caution in the use of IMRT in multi-institutional radiotherapy trials.
In response to the use of advanced technologies in clinical trials, the NCI has created the Advanced Technology Consortium (ATC) cooperative agreement (http://atc.wustl.edu/) to assess these rapid changes and to strive to achieve uniform methods for quality assurance and data management within such trials. NCI also cosponsored, along with the American Society for Therapeutic Radiology and Oncology and the American Association of Physicists in Medicine, a workshop (http://www.oncologymeetings.org/quality_assurance.htm) on the quality assurance challenges of advanced technologies such as IMRT. We agree with Das et al.’s conclusion that there is a "need for national and/or international guidelines for dose prescription, planning, and reporting for a meaningful clinical trial in IMRT," and we point out that the databases that have been created within the current trials by means of the ATC digital data support will allow for retrospective analyses of the prescribed, planned, and reported doses to the target volumes and to organs at risk and of outcomes and adverse events, which will substantially advance the knowledge required for such new guidelines.
REFERENCES
1. Das IJ, Cheng C-W, Chopra KL, et al. Intensity-modulated radiation therapy dose prescription, recording, and delivery: patterns of variability among institutions and treatment planning systems. J Natl Cancer Inst (2008) 100(5):300–307.
2. Willins J, Kachnic L. Clinically relevant standards for intensity-modulated radiation therapy dose prescription. J Natl Cancer Inst (2008) 100(5):288–290.
3. Palta JR, Deye JA, Ibbott GS, et al. Credentialing of institutions for IMRT in clinical trials (Correspondence). Int J Radiat Oncol Biol Phys. (2004) 59(43):1257–1259.[CrossRef][Web of Science][Medline]
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J Natl Cancer Inst 2008 100: 1265-1266.
J Natl Cancer Inst 2008 100: 1266-1267.
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