Quality assurance of axillary radiotherapy in the EORTC AMAROS trial 10981/22023: the dummy run Coen W. Hurkmans a, * , Jacques H. Borger b , Emiel J. Th. Rutgers c , Geertjan van Tienhoven d , On behalf of the EORTC Breast Cancer Cooperative Group and the Radiotherapy Cooperative Group a Department of Radiotherapy, Catharina Hospital, Michelangelolaan 2, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands b Department of Radiotherapy, RTIL, P.O. Box 4446, 6401 CX Heerlen, The Netherlands c Department of Surgery, NKI/AvL, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands d Department of Radiotherapy, AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands Received 25 October 2002; received in revised form 3 April 2003; accepted 21 May 2003; available online 29 August 2003 Abstract Purpose: To assess and if needed improve the compliance of participating institutions to the radiotherapy guidelines of the EO AMAROS trial 10981/22023 comparing axillary radiotherapy to axillary surgery in sentinel node positive patients with early sta cancer. Materials and methods: A transverse contour and a frontal view radiograph of the axillary region of a ‘dummy’ patient were institutions intending to participate in the trial with the request to produce a radiotherapy treatment plan according to the pro Additional information on dose prescription, the treatment technique and field matching with breast fields and internal mamm fields was requested in a questionnaire. Results: Eighteen institutions have performed the dummy run. At first assessment, the dose was not specified according to t seven cases, while two institutions did not comply with the dose prescription of 50 Gy in 25 fractions. Dose heterogeneity was institutions, caused by the use of a two-field technique in eight cases. Ten institutions did not apply special techniques to obtain non- overlapping match planes. In 10 cases, one or more field borders or blocks were positioned incorrectly. Following recommend quality assurance committee given to the participating institutions on an individual basis, 10 institutions adapted their techniq 16 institutions could be accepted for trial participation. Conclusions: A number of potential protocol deviations were found at first assessment. Since recommendations led to a larg adaptations by the participants, a considerable improvement in protocol compliance and inter-institutional consistency was ac q 2003 Elsevier Ireland Ltd. All rights reserved. Keywords: Breast cancer; Axillary radiotherapy; Randomised trial; Quality assurance 1. Introduction A series of randomised trials comparing axillary lymph node dissection (ALND) to radiotherapy in the treatment of primary breast cancer was performed in the 1960s and 1970s [4,9,10,12,19,20]. No differencein survivalwas found between the two approaches exceptfor Guy’strial that showed a worse survival after radiotherapy due to lower axillary control rates [12]. Up to recently, axillary lymph node dissection was considered standard procedure both for diagnosticreasonsand for axillary control.Metastatic canceris present in the axillary lymph nodes in about 40% of the patients [9]. In the remaining 60% of patients, no therapeutic benefit is derived from axillary node dissection 0167-8140/03/$ - see front matter q 2003 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/S0167-8140(03)00194-4 Radiotherapy and Oncology 68 (2003) 233–240 www.elsevier.com/locate/radonline * Corresponding author.