Clinical Trial Credentialing for Stereotactic Radiosurgery and Radiotherapy of Brain Metastases: Recommendations From the TROG SRS Technical Working Group

The uptake of stereotactic radiosurgery (SRS) for the treatment of brain metastases (BM) has been rapid. SRS differs from other forms of radiation therapy in that large radiation doses are typically delivered with small margins for error and high dose heterogeneity. Geometric accuracy relies on the integrity of the entire treatment chain including patient immobilisation, imaging, treatment equipment and verification. Given this requirement for high fidelity geometric and dosimetric accuracy, credentialing for SRS within clinical trials requires special considerations. This process is further complicated by the range of treatment equipment that may be used to deliver SRS. The Trans-Tasman Radiation Oncology Group (TROG) SRS Technical Working Group was established to develop technical guidelines for SRS to BM in clinical trials in Australia, New Zealand and any other countries contributing to TROG recruitment. The panel comprised experts from Radiation Oncology, Medical Physics, Radiation Therapy and the TROG Quality Assurance (QA) team. These guidelines were developed collaboratively to assist trial management committees to formulate SRS credentialing and QA requirements appropriate for the clinical questions addressed by their trial.