Internal Audit of a Comprehensive IMRT Program for Prostate Cancer: A Model for Centers in Developing Countries?
With improving regional prosperity, significant capital investments have been made to rapidly expand radiotherapy capacity across Southeast Asia. Yet little has been reported on the implementation of adequate quality assurance (QA) in patient management. The objective of this study is to perform an in-depth QA assessment of our definitive intensity-modulated radiotherapy (IMRT) program for prostate cancer since its inception.
The department's prostate IMRT program was modeled after that of the University of California San Francisco. A departmental protocol consisting of radiotherapy volume/dose and hormone sequencing/duration and a set of 18 dose objectives to the target and critical organs were developed, and all plans were presented at the weekly departmental QA rounds. All patients treated with definitive IMRT for nonmetastatic prostate cancer were retrospectively reviewed. Protocol adherence, dosimetry data, toxicities, and outcomes were evaluated.
Since 2005, 76 patients received IMRT: 54 with whole-pelvis and 22 with prostate-only treatment. Of the 1,140 recorded dosimetric end points, 39 (3.3%) did not meet the protocol criteria. At QA rounds, no plans required a revision. Only one major protocol violation was observed. Two and two cases of Grade 3-4 acute and late toxicities, respectively, were observed. Five (8.8%) patients developed proctitis, but only one required argon laser therapy.
Our comprehensive, practice-adapted QA measures appeared to ensure that we were able to consistently generate conforming IMRT plans with acceptable toxicities. These measures can be easily integrated into other clinics contemplating on developing such a program.
Available from: Christopher C.K. Ho
- "However, there are also various Asian countries in which 47 to 73% of patients are already in Stage IV during presentation (Mendoza, 2005). Perhaps it has been considered that prostate carcinoma is much less common and low risk in Asia compared to the West and therefore, more attention has been shifted to other diseases thus neglecting this lethal disease (Sim and Cheng, 2005) Few Asian countries, such as Singapore, have moved ahead well in advanced, with the value of PSA upon diagnosis comparable to the west (Koh et al., 2009; Wadhwa et al., 2009) The fact that there are up to 12.1% of our patients defaulted follow-up means that there are patients who would not comply with the treatment regimen provided and rather choose other modes of alternative therapy, which is a common feature in our region. Commonly these patients would only return when the disease has spread to a stage beyond curative intent. "
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ABSTRACT: Analysis of epidemiological as well as survival differences among the multiethnic population of Malaysia with prostate cancer is important.
Patients confirmed by transrectal-ultrasonographic-guided-biopsy performed from 2002 to 2008 were enrolled and analysed according to ethnicity, age, PSA level, Gleason score, stage of disease and survival.
Among 83 patients, there were 38 Malay, 40 Chinese, 3 Indians and 2 others. Median age at diagnosis was 69.9 (range: 59-93), 43 patients (51.8%) being diagnosed before the age of 70. The median PSA level upon diagnosis was 574 ng/ml (range: 1-8632) and the median Gleason score was 7 (range: 2-10). Over half were already in Stage 4 when diagnosed. The most common site of metastasis was the bone. As a result the commonest prescribed treatment was hormonal manipulation. Five patients underwent radical prostatectomy and a further thirteen patients had radical radiotherapy (stage I: 1 patient, stage II: 7 patients and stage III: 5 patients). Ten patients defaulted follow-up. The median disease-specific survival was 21.9 months (range: 1-53).
Prostatic carcinoma is a disease of the elderly and it is frequently diagnosed late in Malaysia. Greater efforts should be made to educate Malaysians regarding prostate cancer.
Available from: Victor Manuel Muñoz-Garzon
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ABSTRACT: RESUMEN Asistimos a un entorno, dentro de la Oncología Radioterápica, de demanda creciente, hemos observado en nuestro centro que la demanda anual crece a un ritmo del 5 -6% anual, con cambios continuos y mayor complejidad de la tecnología y de las técnicas y sin embargo seguimos gestionando nuestros Servicios, sin cambios sustanciales desde hace 20 años. El presente articulo describe el proyecto de cambio de modelo de gestión, basado en la gestión del Flujo de pacientes que el Servicio de Oncología Radioterápica del centro Meixoeiro del CHUVI-Galaria en Vigo , inició en septiembre de 2007, exponiendo los resultados preliminares, que apuntan a que otra forma de gestionar nuestros Servicios es posible y que tanto pacientes como profesionales pueden ganar en el cambio. Conclusión: En este estudio , respecto a la implicación del personal clínico y no clínico en la gestión del flujo de pacientes, la principal conclusión encontrada es que la participación en la gestión del flujo de pacientes mejora el rendimiento de los recursos.
Available from: Samuel Rosales-Pérez
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ABSTRACT: Intensity modulated radiation therapy (IMRT) allows physicians to deliver higher conformal doses to the tumour, while avoiding adjacent structures. As a result the probability of tumour control is higher and toxicity may be reduced. However, implementation of IMRT is highly complex and requires a rigorous quality assurance (QA) program both before and during treatment. The present article describes the process of implementing IMRT for localized prostate cancer in a radiation therapy department. In our experience, IMRT implementation requires careful planning due to the need to simultaneously implement specialized software, multifaceted QA programs, and training of the multidisciplinary team. Establishing standardized protocols and ensuring close collaboration between a multidisciplinary team is challenging but essential.
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