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Published on: March 11, 2021
Internal audit of a comprehensive IMRT program for prostate cancer: a model for centers in developing countries?
Wee Yao Koh1, Wei Ren, Rahul K Mukherjee
1Department of Radiation Oncology, The Cancer Institute, National University Hospital, Singapore.
Summary
This study assessed quality assurance (QA) for prostate intensity-modulated radiotherapy (IMRT) in Southeast Asia. Comprehensive QA measures ensured consistent IMRT plan generation with acceptable toxicity, offering a model for other clinics.
Area of Science:
- Radiation Oncology
- Medical Physics
- Clinical Quality Improvement
Background:
- Southeast Asia has seen significant investment in radiotherapy infrastructure.
- There is a need to evaluate the quality assurance (QA) of patient management in these expanding radiotherapy programs.
- Prostate cancer treatment often involves complex techniques like intensity-modulated radiotherapy (IMRT).
Purpose of the Study:
- To conduct an in-depth quality assurance (QA) assessment of a definitive intensity-modulated radiotherapy (IMRT) program for prostate cancer.
- To evaluate the implementation and effectiveness of QA measures in a real-world clinical setting.
- To establish a benchmark for QA in prostate IMRT programs in the region.
Main Methods:
- Modeled the prostate IMRT program after established international standards (University of California San Francisco).
- Developed a departmental protocol including radiotherapy parameters and hormone therapy guidelines.
- Established 18 dose objectives for target volumes and organs at risk.
- Conducted weekly departmental QA rounds for plan review.
- Retrospectively reviewed data from 76 patients treated with definitive IMRT for nonmetastatic prostate cancer.
- Evaluated protocol adherence, dosimetry, toxicities, and patient outcomes.
Main Results:
- 76 patients treated with IMRT (54 whole-pelvis, 22 prostate-only) from 2005 onwards.
- 3.3% of 1,140 dosimetric endpoints did not meet protocol criteria.
- No plans required revision at QA rounds; only one major protocol violation observed.
- Low rates of Grade 3-4 acute (2 cases) and late (2 cases) toxicities.
- 5.8% of patients experienced proctitis, with only one requiring further treatment.
Conclusions:
- Comprehensive, practice-adapted QA measures successfully ensured consistent generation of conforming IMRT plans.
- The implemented QA program resulted in acceptable toxicity profiles for prostate cancer patients.
- These QA measures are readily adaptable for integration into other radiotherapy clinics developing similar programs.
