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Quality and Excellence in Radiotherapy and Imaging for Children and Adolescents with Cancer across Europe in Clinical Trials

QUARTET (Quality and Excellence in Radiotherapy and Imaging for Children and Adolescents with Cancer across Europe in Clinical Trials) is a radiotherapy quality assurance (RTQA) project that supports the delivery of high-quality radiotherapy for children and adolescents with cancer that are treated in clinical trials across Europe. The QUARTET project supports the creation of standards and investigates the effectiveness of radiotherapy and imaging in paediatric cancers, through an online prospective quality assurance programme.

The ultimate ambition of the QUARTET project, as inscribed within the SIOP Europe Strategic Plan, is to increase cure rates for children with cancer and reduce long-term treatment-related side effects, by establishing quality assurance standards in paediatric radiotherapy and imaging and facilitating equitable access to high-quality treatment. The project also aims to develop research on the role of quality assurance in radiotherapy and to improve understanding of the specific normal tissue tolerances for children and adolescents.


Click the button below to access the list of QUARTET Research Outputs:




Original Scope

The original project design, envisioned inclusion of an estimated 500 patients, over a period of five years. Patients included would receive RTQA for treatment within a number of QUARTET-affiliated trials; aiming to benefit children and adolescents with neuroblastoma, rhabdomyosarcoma, Wilms' tumour, brain tumours, and other sarcomas. All patients included in QUARTET-affiliated trials benefit from prospective quality assurance of radiotherapy treatment plans, with the aim to assuring quality, thus reducing the risk of local recurrence and long-term toxicities.

QUARTET ensures that high standards of radiotherapy treatment are given to all patients enrolled, regardless of where they live. If you know of a trial incorporating radiotherapy and would like to find out more about integrating RTQA using QUARTET email: quartet@siope.eu.

This important project is inscribed in the wider scope of the SIOPE Strategic Plan ‘A European Cancer Plan for Children and Adolescent’, recently endorsed by the paediatric cancer community.

QUARTET is fully supported by Fondatioun Kriibskrank Kanner, Luxembourg, and delivered as a collaborative project between SIOPE and EORTC.

The Fondatioun Kriibskrank Kanner, is a Luxembourg foundation which provides multi-disciplinary support to families of children with cancer, raises awareness to improve the condition of sick children and actively supports pediatric oncology research with one goal: heal better and quicker.

Twitter: #QUARTETproject


Portfolio of QUARTET-affiliated Trials

the portfolio of QUARTET-affiliated trials now consists of:

- 9 trials approved for prospective RTQA

- 1 retrospective radiotherapy analysis

- 2 prospective imaging studies

- 1 retrospective imaging study, and one molecular dosimetry central review program 


Current Status



Activity Type



Prospective RTQA

In set-up, contract signed and awaiting final approval from sponsor to start site approvals and ICR submissions.



Prospective RTQA

Open for site RTQA approvals and ICR submissions 

Prospective Imaging

In set-up, platform testing underway 

Retrospective Imaging (RMS 2005) 



Retrospective RTQA

Closed for submissions,data analysis is being finalised with publication expected in 2024. Four abstracts presented [2-6].


Prospective RTQA

Open for site RTQA approvals and ICR submissions


Prospective RTQA

Open for site RTQA approvals and ICR submissions


Prospective RTQA

In set-up, contract signed and in final stages of set-up. Site approvals with first TCR expected in 2024. 

Contract agreement with sponsor and platform development in progress.


Prospective Imaging



Prospective RTQA

Open for ICR submissions,trial closure and final submissions anticipated in 2024.


Prospective RTQA

On hold pending discussion with sponsor about feasibility of implementation.



Imaging Study

Closed for submissions,all data transfered back to the international sponsor


Prospective RTQA

In set-up, hoping to open in 2024 pending discussion with the international sponsor and radiotherapy leads.



Prospective RTQA

Closed for site RTQA approvals as the trial has been closed. Remain open for ICR submissions,discussion regarding ongoing data,storage,required with the international sponsor. 

MIBG Dosimetry Central Review

Open for ICR submissions for patients treated prior to trial closure.


How To Open A QUARTET Study? 

  • Radiotherapy Lead to contact quartet@siope.eu
  • Sponsor & CI(s) support for QUARTET involvement
  • RTQA to be delivered by QUARTET written into protocol
  • Tri-partisan contract (SIOPE-EORTC-SPONSOR)
  • Reviewer contracts (SPONSOR- Reviewers)


Trial Milestones

Site RTQA Approvals

Site RTQA approvals refers to the pre-trial credentialing procedures required before institutions are able to start recruiting and randomising patients within radiotherapy questions for the QUARTET-affiliated trials.

Site RTQA approval procedures are based upon best international practice, in line with Global Harmonization Group recommendations and adapted from EORTC procedures.

FaR-RMS, HRMB, and HR-NBL2 are all currently open for RTQA approval procedures.



The organisation of QUARTET oversight and organisation was reviewed in 2023 and will be confirmed early 2024.

Membership consists of radiation oncologists (n=65), medical physicists (n=13), radiation therapists (n=4), and other professionals with expertise in trials and/or RTQA or imaging.

Membership is defined across multiple categories and is proposed as follows:

  • Steering Committee: QUARTET leadership comprising of a Chair, Past-Chair, Scientific Development Lead, SIOP Europe representative(s), and SIOP Europe Radiation Oncology Working Group Chair.
  • Research Leads Council: steering committee plus 1-2 representatives/radiotherapy and/or imaging leads from each active clinical trial or major affiliated project. Members may be invited during the initial proposal and development stages of a new trial or major project.
  • QUARTET Research Fellows: current fellows may participate in any activity deemed appropriate by the steering committee to enhance the fellow's learning and to support QUARTET activities. Past fellows may participate as working group or general members, whichever is deemed more relevant to their activities.
  • QUARTET Working Groups: comprised of members across trials with similar interests. Working group members will include trial radiotherapy leads, sponsor representatives, reviewers, research collaborators, and other partners. Invitation to participate should be agreed by the majority and inactive members may be removed.
    • Brain Tumour Working Group 
    • Solid Tumour Working Group 
    • Sarcoma Working Group 
    • Particle Therapy Working Group


Acknowledgements & Collaborations:



QUARTET Contacts


Publications to Highlight:

  • Article: QUARTET: A SIOP Europe project for quality and excellence in radiotherapy and imaging for children and adolescents with cancer (European Journal of Cancer, September 2022)
  • Article: Radiotherapy quality assurance in paediatric clinical trials: first report from six QUARTET-affiliated trials


More information