Dose Volume Effect Relationships (D0.1cm3, D2cm3) Predicting Late Rectal Morbidity in Patients Treated with Concomitant Chemoradiation and MRI-Guided Adaptive Brachytherapy for Locally Advanced Cervical Cancer: A Report from the EMBRACE Study

Mazeron, R.; Fokdal, Lars; Kirchheiner, Kathrin; Georg, Petra; Petrič, Primož; Mahanshetty, Umesh; Hoskin, Peter; Schulz, I.; Kirisists, Christian; Lindegaard, Jacob Christian; Dörr, Wolfgang; Haie-Méder, Christine; Tanderup, Kari; Pötter, Richard

doi:10.1016/j.brachy.2016.04.068

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“…The total dose delivered to the high risk clinical target volume (CTV HR ) and to organs at risk is the result of the sum of the dose delivered by external beam radiotherapy and by brachytherapy, with a significant impact of the relative contribution of each treatment. Numerous data suggest that the ability to achieve a dose distribution fulfilling all treatment planning objectives of the EMBRACE II protocol is improved when the external beam radiotherapy dose is 45 Gy compared with >46 Gy 45 . 46 There is a direct association between the volume irradiated to 43 Gy during external beam radiotherapy and both acute and late bowel morbidity.…”

Section: Original Researchmentioning

confidence: 99%

ESGO/ESTRO quality indicators for radiation therapy of cervical cancer

Chargari

Tanderup

Chiva

et al. 2023

Int J Gynecol Cancer

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BackgroundThe European Society of Gynaecological Oncology (ESGO) has previously defined and established a list of quality indicators for the surgical treatment of cervical cancer. As a continuation of this effort to improve overall quality of care for cervical cancer patients across all aspects, ESGO and the European SocieTy for Radiotherapy and Oncology (ESTRO) initiated the development of quality indicators for radiation therapy of cervical cancer.ObjectiveTo develop a list of quality indicators for radiation therapy of cervical cancer that can be used to audit and improve clinical practice by giving to practitioners and administrators a quantitative basis to improve care and organizational processes, notably for recognition of the increased complexity of modern external radiotherapy and brachytherapy techniques.MethodsQuality indicators were based on scientific evidence and/or expert consensus. The development process included a systematic literature search for identification of potential quality indicators and documentation of scientific evidence, consensus meetings of a group of international experts, an internal validation process, and external review by a large international panel of clinicians (n=99).ResultsUsing a structured format, each quality indicator has a description specifying what the indicator is measuring. Measurability specifications are detailed to define how the quality indicators will be measured in practice. Targets were also defined for specifying the level which each unit or center should be aiming to achieve. Nineteen structural, process, and outcome indicators were defined. Quality indicators 1–6 are general requirements related to pretreatment workup, time to treatment, upfront radiation therapy, and overall management, including active participation in clinical research and the decision making process within a structured multidisciplinary team. Quality indicators 7–17 are related to treatment indicators. Quality indicators 18 and 19 are related to patient outcomes.DiscussionThis set of quality indicators is a major instrument to standardize the quality of radiation therapy in cervical cancer. A scoring system combining surgical and radiotherapeutic quality indicators will be developed within an envisaged future ESGO accreditation process for the overall management of cervical cancer, in an effort to support institutional and governmental quality assurance programs.

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Section: Original Researchmentioning

confidence: 99%