HISTORY

The Quality Assurance Review Center began as the radiation therapy coordinating office for the Cancer and Acute Leukemia Group B (CALGB).  In the late 1970’s, CALGB’s expanded interest in solid tumors resulted in multi-disciplinary protocols that included radiation therapy.  A committee, chaired by Dr. Arvin Glicksman, was established to develop radiation therapy guidelines and to review data.  Submission of radiotherapy data rapidly improved.  However, treatments were not being delivered in a consistent manner among institutions, in spite of protocol guidelines.  Feedback to institutions and presentations of problems at the Cooperative Group meetings improved compliance with protocols.

The CALGB’s success with radiotherapy quality management encouraged other Groups to look to this program for similar support.  This office became the center for radiotherapy quality assurance for the National Wilms Tumor Study Group (NWTSG) and the Intergroup Rhabdomyosarcoma Study Group (IRSG).  In 1980, the Pediatric Oncology Group (POG), established from the pediatric divisions of CALGB and the Southwest Oncology Group (SWOG), asked Dr. Glicksman to direct its radiotherapy quality assurance program.  Independent funding was sought.  In 1980 the Quality Assurance Review Center was funded by the National Cancer Institute (NCI).  Since then, QARC has been continuously funded by NCI to develop and provide radiation therapy quality assurance services for multiple Cooperative Groups.

Over the next 15 years the original programs that were developed evolved and matured.  The foundations remained the four components of a comprehensive quality assurance program:  1. Facilities Inventory; 2. Protocol Development; 3. Data Management; 4. Patient Data Review (Interventional and Final) and Feedback.

Model protocols, templates that could easily be developed into specific protocol guidelines, were developed covering a wide range of treatment techniques and disease sites.  In the last few years, guidelines for new technologies using 3D treatment planning have been developed and incorporated into studies.

Annual performance scores, reflecting both data submission and compliance with treatment guidelines, are reported to the investigators and to the Groups.  In 1991, a major modification in the review process was implemented in the Pediatric Groups.  Institutions with above average performance (>10% above the group mean) were classified as exempt institutions and were no longer required to submit data for pre or on treatment review.  This allowed QARC to concentrate its efforts on institutions not performing well.  The average score of Group performance has risen steadily in the last few years from these changes.  .

Also in 1991 QARC implemented a change in the physics review process.  Until that time the dose calculations for each patient’s treatment were recalculated at QARC.  This required maintaining accurate, up-to-date machine data with profiles of each beam.  The benefit of this review step quickly diminished, as problems were found and corrected and as computers came into use in every department.  The emphasis for physics review was changed to evaluating an institution’s treatment planning process.  To this end, benchmark cases were developed and introduced within each Group.

In 1994, QARC began a major project to upgrade its database, network and computer system.   This has now been completed. Individual protocol patient data tracking and recording has been significantly facilitated.  Reports to Groups were made into routines that can now be readily created and modified.   All patient and institution records existing in the old database were migrated to the new system. 

In 1996, the administration of the QARC grant was transferred to the University of Massachusetts Medical Center (UMass).  In January 1998, Dr. Thomas J. FitzGerald became the Director of QARC, replacing Dr. Glicksman.  Dr. FitzGerald is Director of Radiation Oncology at UMass and a Professor of Radiology. 

Over the years QARC has provided services to many Cooperative Groups, including CALGB, IRSG, NWTSG, POG, CCG (Children’s Cancer Study Group), LCSG (Lung Cancer Study Group), and MAOP (Mid-Atlantic Oncology Program).  Currently, QARC serves ACOS-OG, CALGB, ECOG, COG, the Pediatric Brain Tumor Consortium (PBTC) and SWOG. 

Data on over 30,000 cases on approximately 200 protocols submitted by over 900 radiation therapy facilities are archived at QARC.