Alliance A021501 was the randomized trial that compared neoadjuvant mFOLFIRINOX +/- SBRT for borderline resectable pancreatic cancer. This study evaluated the quality of pancreas SBRT or IMRT treatment plans delivered in the trial. Forty patients were treated with RT across 27 different centers (67% academic, 33% community). Target contours, OAR contours, and target coverage were evaluated by a team of experts. Despite pre-treatment peer review, well over half of cases (59%) were deemed to have either minor (30.8%) or major (28.2%) deviations. The most frequent sources of deviation were suboptimal target volume and OAR contours with suboptimal dose coverage contributing to <10% of deviations. An example of suboptimal target contours was failure to include the SMV tumor vessel interface adjacent to gross disease. | Tchelebi, Int J Radiat Oncol Biol Phys 2023
