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Open Access Research

Quality assurance of radiotherapy in the ongoing EORTC 22042–26042 trial for atypical and malignant meningioma: results from the dummy runs and prospective individual case Reviews

Mehtap Coskun1, William Straube2, Coen W Hurkmans34, Christos Melidis5, Patricia F de Haan6, Salvador Villà7, Sandra Collette5 and Damien C Weber48*

Author Affiliations

1 From the Departments of Radiation Oncology, Ankara Oncology Hospital, Ankara, Turkey

2 From the Departments of Radiation Oncology, Washington University in St. Louis, St. Louis, USA

3 From the Departments of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands

4 QA Strategic Committee, EORTC, Brussels, Belgium

5 From the Departments of Head Quarter, EORTC, Brussels, Belgium

6 From the Departments of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands

7 From the Departments of Institut Català d’Oncologia, HU Germans Trias, Badalona, Catalonia, Spain

8 From the Department of Radiation Oncology, Geneva University Hospital, Radiation Oncology, Geneva, CH-1211, Switzerland

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Radiation Oncology 2013, 8:23  doi:10.1186/1748-717X-8-23

Published: 30 January 2013



The ongoing EORTC 22042–26042 trial evaluates the efficacy of high-dose radiotherapy (RT) in atypical/malignant meningioma. The results of the Dummy Run (DR) and prospective Individual Case Review (ICR) were analyzed in this Quality Assurance (QA) study.


Institutions were requested to submit a protocol compliant treatment plan for the DR and ICR, respectively. DR-plans (n=12) and ICR-plans (n=50) were uploaded to the Image-Guided Therapy QA Center of Advanced Technology Consortium server ( webcite) and were assessed prospectively.


Major deviations were observed in 25% (n=3) of DR-plans while no minor deviations were observed. Major and minor deviations were observed in 22% (n=11) and 10% (n=5) of the ICR-plans, respectively. Eighteen% of ICRs could not be analyzed prospectively, as a result of corrupted or late data submission. CTV to PTV margins were respected in all cases. Deviations were negatively associated with the number of submitted cases per institution (p=0.0013), with a cutoff of 5 patients per institutions. No association (p=0.12) was observed between DR and ICR results, suggesting that DR’s results did not predict for an improved QA process in accrued brain tumor patients.


A substantial number of protocol deviations were observed in this prospective QA study. The number of cases accrued per institution was a significant determinant for protocol deviation. These data suggest that successful DR is not a guarantee for protocol compliance for accrued patients. Prospective ICRs should be performed to prevent protocol deviations.

Radiotherapy; EORTC; Quality assurance; Meningioma; Dummy run; Individual case review