The Dangers of Deviations

Cancer radiation therapy protocol deviations can lead to treatment failure and death

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Cancer radiation therapy is an incredibly intricate procedure that needs to be performed with utter precision for best results. Even the smallest changes can make a difference between success and failure.

Modifying – or deviating from – a radiation protocol can not only impact the success of the treatment, even minor changes to the plan can have an impact on the cancer patient’s life.

Establishing and implementing quality control standards can decrease the possibility of these kinds of errors and help cancer patients live longer.

"Make sure safeguards are in place for your treatments."

Researchers from Thomas Jefferson University Hospital analyzed radiation therapy protocols and quality assurance (QA) standards in place from eight large clinical trials to see how quality assurance (QA) measures affected both treatment and patient outcomes.

More than 2,000 patients participated in the trials the researchers examined. The trials involved patients with lung and brain cancer, Ewing’s sarcoma (bone tumor), pancreatic and head and neck cancers.

Scientists have long agreed that altering radiation therapy protocols in a clinical trial can produce adverse effects. That’s why QA measures have been put in place over the past several decades to decrease these errors.

Using the wrong dosage calculation or not adequately directing radiation to lymph nodes that could spread the cancer are examples of protocol deviations.

Deviations from the radiation protocol were linked with up to a 75 percent increased risk of treatment failure and overall mortality, according to the authors.

Among the trials they looked at, the frequency of deviations ranged anywhere from 8 – 71 percent.

“The magnitude of these effect sizes demonstrates that delivery of high-quality radiation therapy and having a rigorous QA program is critical for the successful execution of clinical trials and for the effective treatment of all cancer patients,” said study author Adam P. Dicker, MD, PhD, chair of the Department of Radiation Oncology at Jefferson and the Kimmel Cancer Center at Jefferson.

“With such practices, deviations decrease and thus overall survival rates for cancer patients improve,” Dr. Dicker said.

Nitin Ohri, MD, who led the study at Jefferson, but is currently at Albert Einstein/Montefiore Medical Center in New York, presented the findings at the American Society for Radiation Oncology (ASTRO) 54th Annual Meeting.

Research that has not yet been published in a peer-reviewed journal is considered preliminary.

Reviewed by: 
Review Date: 
November 5, 2012
Last Updated:
November 6, 2012