Current Status and Future Potential of Advanced Technologies in Radiation Oncology

IMRT Guidelines
In 2004, the NCI first established guidelines for the writing of and participation in NCI-supported cooperative group protocols that employ IMRT. Those guidelines were updated in 2006, and are available at http://atc. wustl.edu/home/NCI/NCI_IMRT_ Guidelines.html. Each institution participating in such an NCI-supported protocol must be credentialed by the group (eg, RTOG, Children’s Oncology Group [COG]) in charge of the protocol.

Proton Radiation Therapy Guidelines
In 2007, the NCI established guidelines for the writing of and participation in protocols that employed protons. Those guidelines are available at http://www.qarc.org/benchmarks/ ProtonGuidelines_June2007.pdf. Each institution participating in such an NCI-supported protocol must be credentialed by the group (eg, RTOG, COG) in charge of the protocol.

Advanced Technology Consortium
The Advanced Technology Consortium (ATC), whose website can be found at http://atc.wustl.edu/, supports the development and execution of, and digital data exchange for, a growing number of clinical trials (both NCI-funded and others) that utilize the advanced technologies. The consortium has devised a methodology for decreasing interinstitutional variations in the key step of submitting information used for verifying the use of registration (fusion) software for combining different kinds of images. It is currently working on a solution to the problem that some treatment planning systems have when calculating doses in the presence of tissue heterogeneities. It is also designing phantoms to simulate target motion due to respiration.[9]

The ATC seeks to create an environment in which clinical investigators can receive, share, and analyze volumetric, multimodality treatment planning and verification digital data, thereby improving the quality of clinical trials involving advanced technology radiation therapy. The quality assurance requirements change as the technology evolves, and also from protocol to protocol depending upon the question(s) being addressed. The ATC develops uniform processes and an infrastructure to assist the cooperative groups in assuring quality, but the actual responsibility for quality assurance belongs to the investigators and cooperative group(s) conducting the trial.

Patient-Reported Outcomes Measurement Information System
Much of the impact of the advanced technologies in radiation oncology, at least in the short-term, will likely be to decrease toxicity by decreasing the volume of nonmalignant tissues subjected to high doses of radiation while treating common cancers. In other words, these technologies may help patients live better (with a better quality of life) rather than longer. Measuring the quality of life can be challenging, however, and many researchers in radiation oncology are not well versed in that methodology.