RTTQA is required to ensure adherence to the outlining and planning aspects of the trial protocol as variations can lead to poorer outcomes. NeoSCOPE, a UK phase II randomized control trial of two neoadjuvant chemoradiotherapy regimens in oesophageal cancer, undertook a comprehensive RTTQA programme with both pre-accrual and prospective on-trial QA of outlining and planning of every patient recruited into the trial.