ESTRO Meets Asia 2024 Congress Report

The Japan Clinical Oncology Group (JCOG) is a multicentre clinical research consortium that is dedicated to cancer treatment and is primarily funded by national research grants in Japan. JCOG's mission is to develop and validate effective standard treatment protocols for various cancer types through nationwide multicentre clinical trials, and thereby enhance the quality and outcomes of cancer research. Currently, JCOG comprises 16 study groups, including a dedicated radiation therapy group, with approximately 190 institutions involved in its clinical trials. At present, 25 ongoing clinical trials utilise radiation therapy within the JCOG framework. Among these, one trial employs proton therapy, while 13 trials utilise intensity-modulated radiation therapy (IMRT). The number of clinical trials that incorporate IMRT has increased each year.

In clinical trials that involve radiation therapy, it is crucial to ensure the quality of the provided radiotherapy through quality assurance (QA). QA in radiation therapy consists of three main components: benchmark cases, dosimetry audits, and individual case reviews. Dosimetry audits, which was the focus of my presentation, involves the assessment of whether or not institutions can implement accurately specific treatment techniques such as IMRT. Large differences in quality among facilities that participate in a clinical trial can lead to suboptimal clinical outcomes. Therefore, it is vital to identify such facilities in advance. Processes to conduct dosimetry audits help to mitigate these differences and enhance the overall quality of clinical outcomes.

There are three types of IMRT dosimetry audits: on-site, postal, and virtual. In my presentation, I focused on virtual audits. Unlike postal audits, virtual audits do not require the physical shipment of phantom sets, as the measurement equipment is provided by the audited institution. The analysis is performed by auditors rather than local staff to ensure an independent review process. Virtual audits are expected to be more efficient and cost-effective, and to facilitate faster case enrolment, compared with on-site and postal audits.

To meet the increasing demands for IMRT dosimetry audits in JCOG clinical trials, we are developing a virtual audit system to replace the existing postal version. Below is an overview of our virtual audit process. The procedure begins with the auditor uploading the DICOM data that is necessary for dosimetry audits to a designated server. Each participating institution then downloads this DICOM data and develops a treatment plan in line with the provided manual. Subsequently, the institution administers the dose using its measurement tools. Once the measurements and treatment plan data have been recorded, they are re-uploaded to the server for automatic analysis. After the analysis, an automated report is generated. This report includes the results and supplementary information such as the institution's name, the physician's name, the linear accelerator used, and other relevant details. The generation of the report typically requires only a few minutes. The content of my presentation is detailed in the paper [1].

Mitsuhiro Nakamura, PhD.

Kyoto University, Kyoto, Japan

m_nkmr@kuhp.kyoto-u.ac.jp

[1] Mitsuhiro Nakamura, Dejun Zhou, Toshiyuki Minemura, et al. A virtual audit system for intensity-modulated radiation therapy credentialing in Japan Clinical Oncology Group clinical trials: A pilot study. J Appl Clin Med Phys. 2023 Jun;24(6):e14040.