Lungtech, a phase II EORTC trial of SBRT for centrally located XXXX - a clinical physics perspective.

@entity5 @entity1 @entity137
BACKGROUND: The EORTC has launched a phase II trial to assess safety and efficacy of SBRT for centrally located NSCLC: The EORTC 22113-08113-Lungtech trial. Due to neighbouring critical structures, these @entity5 remain challenging to treat. To guarantee accordance to protocol and treatment safety, an RTQA procedure has been implemented within the frame of the EORTC RTQA levels. These levels are here expanded to include innovative tools beyond protocol compliance verification: the actual dose delivered to each @entity1 will be estimated and linked to trial outcomes to enable better understanding of dose related response and @entity137 . METHOD: For trial participation, institutions must provide a completed facility questionnaire and beam output audit results. To insure ability to comply with protocol specifications a benchmark case is sent to all centres. After approval, institutions are allowed to recruit @entity1 . Nonetheless, each treatment plan will be prospectively reviewed insuring trial compliance consistency over time. As new features, @entity1 's CBCT images and applied positioning corrections will be saved for dose recalculation on @entity1 's daily geometry. To assess RTQA along the treatment chain, institutions will be visited once during the time of the trial. Over the course of this visit, end-to-end tests will be performed using the 008ACIRS-breathing platform with two separate bodies. The first body carries EBT3 films and an ionization chamber. The other body newly developed for PET- CT evaluation is fillable with a solution of high activity. 3D or 4D PET-CT and 4D-CT scanning techniques will be evaluated to assess the impact of motion artefacts on target volume accuracy. Finally, a dosimetric evaluation in static and dynamic conditions will be performed. DISCUSSION: Previous data on mediastinal @entity137 are scarce and source of cautiousness for setting-up SBRT treatments for centrally located NSCLC. Thanks to the combination of documented @entity1 related outcomes and CBCT based dose recalculation we expect to provide improved models for dose response and dose related @entity137 . CONCLUSION: We have developed a comprehensive RTQA model for trials involving modern radiotherapy. These procedures could also serve as examples of extended RTQA for future radiotherapy trials involving quantitative use of PET and @entity5 motion.
