Even credentialed institutions can miss the mark on extended-field cervical IMRT, as NRG-GY017 demonstrates in this prospective pre-treatment QA analysis. Across 37 centrally reviewed plans, a striking 35% (13 plans) carried major deviations requiring revision before treatment could begin. The culprits were almost entirely contouring: 11 of 13 were target or OAR delineation errors (split between nodal volumes (6) and bowel (5)) with just 2 stemming from incorrect volume expansions or dose distribution. Nodal misses clustered in the para-aortic region and in omitted basins with one illustrative case failing because the external iliac nodes were left out of the lymph node volume entirely. The recurring theme is that extended-field nodal delineation and small-bowel contouring remain genuinely hard, and SIB to involved nodes near bowel raises the stakes. | Mayadev, Int J Radiat Oncol Biol Phys 2026
