Multicentre clinical radiotherapy audit in rectal cancer: results of the IROCA project
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REVIEW
Open Access
Multicentre clinical radiotherapy audit in rectal cancer: results of the IROCA project Magdalena Fundowicz1* , Artur Aguiar2, Carla Lopes de Castro2, Maria Glòria Torras3, Letizia Deantonio4, Ewelina Konstanty1, Marta Kruszyna-Mochalska1,5, Miquel Macia3, Eugeni Canals6, Monica Caro7, Carla Pisani4, Dorota Zwierzchowska1, Jaume Molero7, Arantxa Eraso3, Joana Lencart2, Carles Muñoz-Montplet3, Luisa Carvalho2, Marco Krengli4, Julian Malicki1,5 and Ferran Guedea3
Abstract Purpose: To perform a clinical audit to assess adherence to standard clinical practice for the diagnosis, treatment, and follow-up of patients undergoing radiotherapy for rectal cancer treatment in four European countries. Materials and methods: Multi-institutional, retrospective cohort study of 221 patients treated for rectal cancer in 2015 at six European cancer centres. Clinical indicators applicable to general radiotherapy processes were evaluated. All data were obtained from electronic medical records. Results: The audits were performed in the year 2017. We found substantial inter-centre variability in adherence to standard clinical practices: 1) presentation of cases at departmental clinical sessions (range, 0–100%) or multidisciplinary tumour board (50–95%); 2) pretreatment MRI (61.5–100%) and thoracoabdominal CT (15.0–100%). Large inter-centre differences were observed in the mean interval between biopsy and first visit to the radiotherapy department (range, 21.6–58.6 days) and between the first visit and start of treatment (15.1–38.8 days). Treatment interruptions ≥ 1 day occurred in 43.9% (2.5–90%) of cases overall. Treatment compensation was performed in 2.1% of cases. Treatment was completed in the prescribed time in 55.7% of cases. Conclusions: This multi-institutional clinical audit revealed that most centres adhered to standard clinical practices for most of the radiotherapy processes-related variables assessed. However, the audit revealed marked inter-centre variability for certain quality indicators, particularly inconsistent record keeping. Multiple targets for improvement and/or harmonisation were identified, confirming the value of routine clinical audits to detect potential deviations from standard clinical practice.
Introduction Rectal cancer accounts for approximately one third of all cancers diagnosed in Europe [1]. In most cases, treatment consists of a combination of radiotherapy, chemotherapy, and surgery [2]. The use of high-dose ionising radiation, particularly in the pelvic region, requires strict quality control measures to achieve optimal outcomes while minimizing toxicity to surrounding healthy organs * Correspondence: [email protected] 1 Greater Poland Cancer Centre, Garbary 15 St, 61-866 Poznan, Poland Full list of author information is available at the end of the article
[3]. In recent years, the role of clinical audits in improving quality has been increasing recognized. However, to date only a limited number have been conducted in the field of radiation oncology [4–8], and even fe
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