Type of publication:
Conference abstract
Author(s):
Perera J.; Bhana R.; *Choudhury Y.; Devleena D.; Seedhouse I.; Tsui S.M.
Citation:
Clinical Oncology. Conference: SUPP: RCR Audit & QI ePoster Competitions 2024. InterContinental Hotel, Dubai Festival City United Arab Emirates. 40(Supplement 1) (no pagination), 2025. Article Number: 103820. Date of Publication: 01 May 2025.
Abstract:
Category: Gynaecology Background to the audit: Standard treatment for locally advanced cervix cancer consists of chemoradiotherapy followed by brachytherapy. Trial data show shortening overall treatment time and escalation of doses to the high-risk clinical target volume (HR-CTV) to be associated with better local control. Image-guided brachytherapy (IGBT) enables greater dose conformity and local control.<sup>1-6</sup>UHNM commenced a magnetic resonance-based IGBT service for cervical cancer in 2016. Standard: BGCS/ESGO/ESTRO/ESP/ASTRO guidelines on management of cervical cancer.<sup>7-9</sup>1. Overall treatment time should not exceed 49-56 days. 2. Total equivalent dose in 2 Gy fractions (EQD2) to 90% of the HR-CTV (D90) to be >=85 Gy. Indicator: Percentage of patients meeting each standard. Target: 100% having overall treatment less than 56 days. 90% achieving the dose to HR-CTV targets keeping organs at risk(OAR) within tolerence. Methodology: Retrospective analysis of data on IGBT for radical cervical cancer treatments from 1 January 2021 to end of March 2023 done and reviewed at May 2023 UHNM brachytherapy meeting. Initial time span selected to minimise impact of COVID. Action plan implemented and patient data for April 2023 to April 2024 re-audited. Results of first audit round: 43 UHNM and Shrewsbury patients treated. Overall treatment time data available only for 20 UHNM patients. 1 (5%) had exceeded 56 days and 7 (35%) had taken 50-56 days to complete. 37/43 (86.1%) had received a D90 HR-CTV of >85 Gy. A linear relationship between external beam radiation therapy (EBRT) completion to brachytherapy start with total treatment duration identified. First action plan: Pathway changes made to commence chemoradiotherapy on Monday/Tuesday and to schedule the whole course of chemoradiotherapy and brachytherapy at the time of referral. Ring and tandem commissioned as a priority to allow more applicator options. Results of second audit round: All 26 (100%) UHNM and Shrewsbury patients had completed treatments within 56 days. 73.1% within 49 days. 1 outside patient's chemoradiotherapy data incomplete. HR-CTV D90 >85 Gy in 85.2%. 8 patients treated with ring and tandem with 60% more needle use compared with ovoids. No patient exceeded mandatory OAR tolerences. Second action plan: Proactively scheduling brachytherapy, liaising with the regional network monthly to optimise timing and resources usage. To continue with dosimetric data collection to optimise needle placement and to review impact of needles on OAR doses and clinical outcomes in the next audit.
