A glance on quality assurance in EORTC study 22922 evaluating techniques for internal mammary and medial supraclavicular lymph node chain irradiationin breast cancer

Purpose: To evaluate the irradiation techniques used for the irradiation of the internal mammary and medial supraclavicular lymph node chain (IM-MS) i n the EORTC 22922 study, which evaluates its impact on survival in stage I- III breast cancer patients with axillary node invasion and/or central or me dial location of the primary tumour. Materials and methods: The analysis was performed based on the dummy run da ta of the Quality Assurance Programme of the study. A standard irradiation technique was proposed within the study protocol, and the use of other trea tment set-up techniques was allowed. Results: By March 2000, 39 centres from 12 different countries had particip ated in the study; 32 of these had already fulfilled the dummy run procedur e. No centres had to be excluded from the study. Seventy-eight percent of t he centres are using the standard irradiation technique, 64% of these with minor variations. Twenty-two percent of the centres developed an alternativ e irradiation technique. The remarks to the centres using the standard set- up were most often related to the junction problem and the possible under- or overdosage in the target volumes. The remarks to the centres with altern ative techniques most often concerned the possible enhanced dose to the lun gs and the heart. Conclusion: In a multi-centre trial an easy irradiation technique applicabl e in a large number of centres should be provided. A quality assurance prog ramme allows early detection of possible problems with treatment planning a nd delivery. The analysis of the dummy run data showed that if the recommen dations of the Quality Assurance Committee are applied, both standard and a lternative IM-MS irradiation techniques produce acceptable dose distributio ns. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.