Recognising the challenges of implementing multi-centre adaptive plan of the day radiotherapy.

Two multicentre adaptive radiotherapy trials utilising Plan of the Day (PoD) with a library of plans were introduced in 35 centres. The common issues that arose from all centres when introducing PoD were collated retrospectively, through reviewing the data pertaining to the pre-trial and on-trial quality assurance programme. It was found that 1,295 issues arose when introducing PoD in outlining, planning, treatment delivery i.e., PoD selection, and in the overall process of delivering PoD. There was no difference in the number of issues that arose from pre-trial to on-trial. Thus, it is recommended that the implementation of PoD is supported by guidance, reviews, and continuous monitoring.

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Déclaration de conflit d'intérêts

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Shaista Hafeez: SH acknowledges support from the National Institute for Health Research (NIHR) Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London. SH reports non-financial support from Elekta (Elekta AB, Stockholm, Sweden), non- financial support from Merck Sharp & Dohme (MSD), personal fees and non-financial support from Roche outside the submitted work. Emma Hall: EH declares grant funding to Institution from Cancer Research UK; grant funding to Institution from Accuray Inc. and Varian Medical Systems Inc. outside the submitted work. Other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.