ESGO/ESTRO quality indicators for radiation therapy of cervical cancer

Abstract

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.

Neoadjuvant chemotherapy followed by surgery versus concurrent chemoradiotherapy in patients with stage IIB cervical squamous cell carcinoma: a retrospective cohort study

“…This reality might incline clinicians toward considering surgical interventions for these patients. However, recent studies indicate that achieving an optimal dose distribution, compliant with the treatment planning objectives of the EMBRACE II protocol, is more feasible when the external beam radiotherapy dose is limited to 45 Gy [ 25 ]. Moreover, the systematic use of an interstitial brachytherapy component can increase the dose delivered to 98% of the volume from 83 ± 14 Gy to 92 ± 13 Gy without increasing the dose to organs at risk.…”

AEBP1 upregulation contributes to cervical cancer progression by facilitating cell proliferation, migration, and invasion

“…[2][3][4] Surgery is the primary modality of treatment and radiotherapy is the commonly used adjuvant treatment. 5,6 Despite worldwide screening and advances in early diagnosis and improved treatments, the prognosis is unsatisfied especially in patients with advanced cervical cancer. There is an urgent need to discover the underlying mechanisms of cervical cancer progression and explore new effective treatments to further enhance the treatment effect.…”

The Use of 3D Printing Technology in Gynaecological Brachytherapy—A Narrative Review

“…Sixteen percent of all inserted needles were freehand and inserted at an oblique angle [ 17 ]. Since then, the use of interstitial needles has increased and the proportion of interstitial component use now represents one of the quality indicators for the management of cervical cancer, with at least 40% of patients treated with the combined IC/IS approach being the minimum required and ≥60% representing the optimal target [ 18 ].…”