Quality indicators for prostate radiotherapy: Are patients disadvantaged by receiving treatment in a ‘generalist’ centre?

Abstract

Introduction: The purpose of this retrospective review was to evaluate concordance with evidence-based quality indicator guidelines for prostate cancer patients treated radically in a 'generalist' (as distinct from 'sub-specialist') centre. We were concerned that the quality of treatment may be lower in a generalist centre. If so, the findings could have relevance for many radiotherapy departments that treat prostate cancer. Methods: Two hundred fifteen consecutive patients received external beam radiotherapy (EBRT) and/or brachytherapy between 1.10.11 and 30.9.12. Treatment was deemed to be in line with evidence-based guidelines if the dose was: (i) 73.8-81 Gy at 1.8-2.0 Gy/fraction for EBRT alone (eviQ guidelines); (ii) 40-50 Gy (EBRT) for EBRT plus high-dose rate (HDR) brachytherapy boost (National Comprehensive Cancer Network (NCCN) guidelines); and (iii) 145 Gy for low dose rate (LDR) I-125 monotherapy (NCCN). Additionally, EBRT beam energy should be ≥6 MV using threedimensional conformal RT (3D-CRT) or intensity-modulated RT (IMRT), and high-risk patients should receive neo-adjuvant androgen-deprivation therapy (ADT) (eviQ/NCCN). Treatment of pelvic nodes was also assessed. Results: One hundred four high-risk, 84 intermediate-risk and 27 low-risk patients (NCCN criteria) were managed by eight of nine radiation oncologists. Concordance with guideline doses was confirmed in: (i) 125 of 136 patients (92%) treated with EBRT alone; (ii) 32 of 34 patients (94%) treated with EBRT + HDR BRT boost; and (iii) 45 of 45 patients (100%) treated with LDR BRT alone. All EBRT patients were treated with ≥6 MV beams using 3D-CRT (78%) or IMRT (22%). 84%, 21% and 0% of high-risk, intermediate-risk and low-risk patients received ADT, respectively. Overall treatment modality choice (including ADT use and duration where assessable) was concordant with guidelines for 176/207 (85%) of patients. Conclusion:The vast majority of patients were treated concordant with evidence-based guidelines suggesting that, within the limits of the selected criteria, prostate cancer patients are unlikely to be disadvantaged by receiving radiotherapy in this 'generalist' centre.

Radiation Oncology Quality Assessment Tool: A proposal for a new audit tool in modern radiation oncology

“…There have been previous debates about the quality of radiation therapy delivered in generalist, low volume or regional centres . Our results were consistent with other studies showing high rates of adherence to protocols by generalist and regional centres . As pointed out by Shakespeare et al ., this may be related to more modern technology and processes within a new department.…”

Quality indicators for early stage Hodgkin's lymphoma

“…It is noteworthy and reassuring that good adherence to the RT component of the QIs, in particular, is possible in a ‘generalist’ centre such as the RAH Radiation Oncology department. This was also recently found to be the case for management of early prostate cancer at the same institution …”

“…This was also recently found to be the case for management of early prostate cancer at the same institution. 14 It should be acknowledged that the GHSD HD10 and HD11 recommendations (and hence eviQ guidelines) are by no means definitive or universally followed either in Australia or overseas, reflecting the fact that ESHL is a malignancy eminently curable by a variety of approaches. Treatment de-intensification underlying the GHSG philosophy is a departure from long held practices which may be challenging to abandon.…”

Improving radiation oncology through clinical audits: Introducing the IROCA project

“…The selection of quality indicators in radiotherapy has been keenly debated in recent years. 3,20 In prostate radiotherapy, several groups have developed quality indicators [6][7][8] although it should be noted that many of these indicators have not yet been validated.…”

“…This process, known as a clinical audit, provides an opportunity to conduct an in-depth analysis of the procedures and processes governing patient care. To date, such clinical audits have been used only sparingly in radiotherapy, 2,3,8 although measures to increase their use have been taken, including a European Union directive requiring their use. 4 Interest in developing and implementing a system of quality standards in radiotherapy has increased greatly in recent years.…”