Implementation of state-of-the-art (chemo)radiation for advanced cervix cancer in the Netherlands: A quality improvement program

Abstract

To report on the ''Dutch Quality Improvement Project" regarding external beam (EBRT) and brachytherapy (BT) contouring and treatment planning for locally advanced cervical cancer (LACC). Material and methods: Two rounds of three workshops were organized. Data from two patients with LACC were made available for homework exercises. Contouring and treatment planning was asked for according to the EMBRACE-II protocol. The submissions were analysed and the results were addressed during the workshops. Results: Almost all invited centres participated. EBRT contouring guidelines were followed within acceptable range, with major effort needed with regard to the ITV concept. BT contouring was of good quality, with especially small discrepancies for centres already participating in EMBRACE. EBRT treatment planning results improved between workshops with more centres being able to fulfil the planning aims. Guidance was especially necessary to improve the coverage probability planning for affected nodes. For BT planning prioritizing between target coverage and OAR sparing improved over time; the variation in dose to vaginal points remained considerable, as did variation in loading patterns and spatial dose distribution. The project was highly appreciated by all participants. Conclusion: Homework and workshop activities provide a suitable platform for discussion, exchange of experience and improvement of quality and conformity. Due to this project, radiotherapy for LACC can be administered with better and more comparable quality throughout the Netherlands.

Evaluation of the impact of EMBRACE II protocol in Spanish centers, with a large cohort of patients using a ranking index

“…Recently, De Leeuw et al . [ 19 ] presented a report concerning a Dutch national quality assurance program for state-of-the-art curative radiotherapy for patients with LACC. This project was useful to show the need for training concerning the adaptation to the new EMBRACE II treatment protocol.…”

Education and training for image-guided adaptive brachytherapy for cervix cancer—The (GEC)-ESTRO/EMBRACE perspective

“…Between 2008 and 2012, 27 centers were accredited through the EMBRACE-I RTQA process with an additional 27 centers accredited through the EMBRACE-II RTQA process since 2016. In the Netherlands, the principles and content of the EMBRACE-II RTQA process were used to develop a national quality improvement program for all Dutch centers regardless of trial participation (45).…”

Multi-center analysis of machine-learning predicted dose parameters in brachytherapy for cervical cancer

“…Depending on the patient and the use of interstitial needles, these constraints can be more easily met. To ensure a minimum quality of the treatment plans, the use of dummy-runs has been reported to improve familiarity with the protocol and to homogenize results among institutes [8][9][10][11]. Cohort analyses and comparisons of dose-volume parameters with other institutes can give insight in an institute's plan quality and possibly provide guidance for general improvement.…”