S1521
Interdisciplinary - Quality assurance and risk management
ESTRO 2026
analysis excluding 43 RTQA-reviewed cases lacking final corrected contours, which were not resubmitted following feedback, was undertaken. This did not alter the results.Contour re-review identified additional protocol violations in 32.8% (n=43) of cases previously deemed acceptable (n=131). This predominantly involved under coverage of the inferior duodenum(n=28).
chemoradiation therapy for gastric cancer. Int J Radiat Oncol Biol Phys. 2023;117(4):850-859. doi:10.1016/j.ijrobp.2023.07.012. Keywords: RTQA, gastric cancer, contouring
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Predicting Cardiotoxicity in Stage III Lung Cancer: Integrating Coronary Calcium and LAD Coronary Dosimetry Eugènia Otero Pla 1 , Joan Carles Julià Sanahuja 1 , Pedro Gallego Franco 2 , Ana Maria Soto cambres 1 , Gemma Calvet Molinas 1 , Scarlet Marie Crespo Pérez 1 , Maria Magdalena Piedra Argudo 1 , Andrea Ejimeno Castejón 1 , Belen Sopena Carrera 1 , Josep Balart Serra 1 , Arantxa Mera Errasti 1 , Josep Isern Vedrum 1 , Antonio Vila Capel 1 , Jady Vivian Rojas Cordero 1 , Laura Montezuma Niño 1 , Katarina Majercakova 1 , Sonia Bermejo Martínez 1 , Gemma Sancho Pardo 1 , Núria Farré Bernadó 1 1 Radiation Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 2 Medical Physics, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain Purpose/Objective: To evaluate whether coronary artery calcium (CAC) combined with Left Anterior Descending (LAD) coronary artery dosimetry can predict cardiotoxicity in stage III lung cancer patients. Material/Methods: We retrospectively analyzed 185 patients with stage III lung cancer treated between 2015 and 2023. A subanalysis of this cohort was conducted in those patients who experienced cardiac events (n=15), and compared with a control group of randomly selected patients (n = 28). The LAD coronary artery was contoured using AI-assisted Slicer 3D Software; and CAC was identified using a custom script within Eclipse Scripting Application Program Interface (ESAPI) applied to planning CT scans. Dosimetric parameters included LAD total volume, V5, V30, V40, and V50. Statistical analyses were performed using IBM SPSS v29.0. Results: Median age was 63 years (56–83), 90.7% were smokers, 74.4% had cardiovascular risk factors, and 37.2% had prior cardiac disease. Treatments included concomitant (65%) or sequential (28%) chemoradiotherapy, radiotherapy alone (7%), adjuvant immunotherapy (9%), and surgery (19%). The median time-to-first cardiac event was 23.8 months (range, 2.04 - 85.7). Analysis of dosimetric parameters showed a significant trend toward higher dose values in patients with cardiac events for Dmax-LAD (p= 0.178), V5-LAD (p= 0.182), V50-LAD (p= 0.09), and the presence of CAC (p= 0.13). Logistic regression analysis of clinical and dosimetric variables detected statistical
Conclusion: No statistically significant survival or toxicity differences were observed by RTQA status. The absence of outcome difference suggests that the lack of benefit from CRT was not significantly confounded by variations in radiotherapy quality.Secondary review identified additional violations in 32.8% of cases emphasising the importance of ongoing RTQA improvement in prospective trials. These did not impact outcomes, suggesting most were minor and clinically acceptable. Consistent omissions (e.g. inferior duodenum) revealed common areas of contouring error that could be addressed by AI-based automated RTQA tools to enhance trial consistency and RTQA efficiency without delaying treatment. References: 1. Leong T, Smithers BM, Michael M, Haustermans K, Wong R, Gebski V, O’Connell RL, et al. Preoperative chemoradiotherapy for resectable gastric cancer. N Engl J Med. 2024 Sep 13;391(19):1810-1821. doi:10.1056/NEJMoa2405195.2. Lukovic J et al. The feasibility of quality assurance in the TOPGEAR international phase 3 clinical trial of neoadjuvant
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