Credentialing for RTOG 1308
Knowledge Assessment Questionnaire

This questionnaire is intended to evaluate your understanding of the protocol. If there are any
questions please contact the IROC Houston at (713) 745-8989 or IROCHouston@mdanderson.org

 
Facility Name:  
Provide the Facility’s member number: RTOG#: RTF#  
Name of Radiation Oncologist completing this form:  
Email address of Radiation Oncologist: Phone Number:  
Name of Physicist: Phone Number:  
Email address of Physicist:  
Institution(s) where you're planning to treat photons:  
Institution(s) where you're planning to treat protons:  
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PHOTON institutions: Complete questions 1-18
PROTON institutions: Complete questions 1-16, 19-20
1. In order to be eligible to enroll patients onto this trial, the center must be approved to use therapy
  by the IROC Houston, be credentialed both for photon and/or and be credentialed for
  lung image-guided radiotherapy (IGRT).
2. Both arms will be given with concurrent platinum-based chemotherapy?  
3. Protocol treatment must begin within calendar days after registration and within
  calendar days after simulation.  
4. Patients in both proton and photon arms will receive treatments days per week using Gy
  (RBE) per fraction. RBE used will be for protons and 1 for photons. The total prescribed dose will be  
  Gy (RBE) without exceeding tolerance dose-volume limits of all critical normal structures.    
5. If the prescription dose of 70 Gy (RBE) cannot be achieved within the stated normal tissue constraints, the
  treatment plan must be submitted for pre-treatment review.    
6. Dose distribution will be normalized to cover % of the PTV with the prescription dose. A volume of no    
  no more than cc inside PTV should exceed % of the prescribed dose.
7. Contiguous CT slices, having no more than mm thickness are to be obtained starting from the level
  of the and extending inferiorly through the entire volume.
8. Site physics staff who will submit images through will need to be registered with The Cancer  
  Therapy Evaluation Program (CTEP) and have a valid and active CTEP Identity and Access Management (IAM) account.
9. This study will utilize Medidata Rave® for remote data capture (RDC) of all data?  
10. If end-to-end tumor motion is > mm (+/- mm relative to the mean position),  
  the use of ITV  approach is discouraged.
11.

Volume Definitions (fill in the appropriate letter in the blank):

 
GTV
iGTV
CTV
ITV
PTV
a. ITV plus a margin to ensure that the prescribed dose is actually delivered to the ITV. This margin accounts for variations in treatment delivery, including variations in setup between treatments. The ITV is expanded isotropically by 5 mm to generate this volume.
b. Subclinical involvement around the GTV, equal to the GTV plus an 8-mm margin for micro extensions of the tumor without extending into uninvolved organs, such as the esophagus, heart, or bone.

c. GTV plus margin for tumor motion. This structure will be created equal to the union of the GTV on all respiratory correlated images
d. The envelope of the CTV during the time of irradiation, thus accounting for intrafractional motion. It may equivalently be created in one of two ways: (1) by expanding the iGTV by 8 mm to include subclinical microscopic disease without extending into uninvolved organs, such as the esophagus, heart, or bone; or (2) by combining all CTVs in all respiratory phases.
e. Gross disease as demonstrated on the planning CT, and modified as deemed necessary based on PET and other imaging studies.
12. Lungs should be contoured on the image of the 4D CT scans for free-breathing based treatments
  or the mid position of gated planning CTs for gated treatments, or on the breath-hold CT for breath-hold treatments.
13. All contours and treatment plans for the first proton cases and the first photon cases
  from each participating institution will have pretreatment review by the protocol PIs or a radiation oncologist designee.
14. Dose constraints for critical structures are (fill in the appropriate letter in the blank):
 
Normal Lung
Esophagus
Brachial Plexus
Spinal Cord
Heart
a. V70 ≤ 3.0 cc
b. V30 ≤ 50%
c. 74 Gy (RBE) ≤ 1cc of partial circumference
d. V20 ≤ 37%
e. V50 < 0.03 cc
15. Patient will be treated only on units with image guidance capabilities?  
16. Additional repeating (CT imaging) studies must occur at the end of week (between days 13-15),
  and middle of week (between days 29-32) from the date of treatment start.  
Photon ONLY
17. IMRT is allowed?  
18. Pre-Registration Requirements for IMRT Treatment Approach: An IMRT phantom study with the IROC Houston
  must be successfully completed?  
Proton ONLY
19. IMPT is NOT allowed?  
20. For proton planning, each beam has an individual and unique PTV expansion from the ITV?