Improving radiation oncology through clinical audits: Introducing the IROCA project

Torras, M.G.; Fundowicz, Magdalena; Aliste, Luisa; Asensio, Esther Pérez; Boladeras, A.; Borrás, Josep María; Carvalho, L.; Castro, Carolina Moreno; Deantonio, Letizia; Konstanty, Ewelina; Krengli, Marco; Kruszyna, M.; Lencart, Joana; Macià, Miquel; Marin, S.; Muñoz-Montplet, C.; Pisani, Carla; Pinto, Daniel; Puigdemont, Montserrat; Guedea, Ferrán; Aguiar, Artur; Milecki, Piotr; Malicki, Julian

doi:10.1016/j.rpor.2017.07.004

Cited by 10 publications

(8 citation statements)

References 19 publications

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“…Although we have sought to put the findings of the present audit in the context of other studies, it is difficult to compare results due to methodological differences, particularly due heterogeneity in the parameters evaluated. Comparison is further hindered by the scant data available and because the parameters must, of necessity, vary according to tumour type, as evidenced in the previous IROCA studies for prostate and rectal cancer 9 , 44 . In this regard, we still lack a set of internationally recognized, standardized indicators to permit international comparisons among radiotherapy centres 3 , despite efforts made by several different groups 3 – 5 , 11 , 45 .…”

Section: Discussionmentioning

confidence: 99%

“…Given the importance of quality assurance in radiotherapy, six comprehensive cancer centres in Europe initiated a multicentric systematic clinical audit project to improve the quality of radiotherapy. The primary aim of this project—known IROCA ( Improving Quality in Radiation Oncology through Clinical Audits; https://iroca.eu ) 9 was to develop and apply a clinical audit model to assess adherence to core quality indicators to evaluate the key radiotherapy processes related to planning and delivery.…”

Section: Introductionmentioning

confidence: 99%

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Results of the IROCA international clinical audit in prostate cancer radiotherapy at six comprehensive cancer centres

Castro

Fundowicz

Roselló

et al. 2021

Sci Rep

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To assess adherence to standard clinical practice for the diagnosis and treatment of patients undergoing prostate cancer (PCa) radiotherapy in four European countries using clinical audits as part of the international IROCA project. Multi-institutional, retrospective cohort study of 240 randomly-selected patients treated for PCa (n = 40/centre) in the year 2015 at six European hospitals. Clinical indicators applicable to general and PCa-specific radiotherapy processes were evaluated. All data were obtained directly from medical records. The audits were performed in the year 2017. Adherence to clinical protocols and practices was satisfactory, but with substantial inter-centre variability in numerous variables, as follows: staging MRI (range 27.5–87.5% of cases); presentation to multidisciplinary tumour board (2.5–100%); time elapsed between initial visit to the radiation oncology department and treatment initiation (42–102.5 days); number of treatment interruptions ≥ 1 day (7.5–97.5%). The most common deviation from standard clinical practice was inconsistent data registration, mainly failure to report data related to diagnosis, treatment, and/or adverse events. This clinical audit detected substantial inter-centre variability in adherence to standard clinical practice, most notably inconsistent record keeping. These findings confirm the value of performing clinical audits to detect deviations from standard clinical practices and procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Results of the IROCA international clinical audit in prostate cancer radiotherapy at six comprehensive cancer centres

Castro

Fundowicz

Roselló

et al. 2021

Sci Rep

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“…In recent years, the role of clinical audits in improving quality has been increasing recognized. However, to date only a limited number have been conducted in the field of radiation oncology [4][5][6][7][8], and even fewer have specifically focused on rectal cancer [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…In this context, six European comprehensive cancer centres joined together in an international project known as IROCA (Improving Quality in Radiation Oncology through Clinical Audits; https://iroca.eu) to carry out clinical audits of the radiotherapy process [10]. This project was, in part, inspired by previous experience at two of these hospitals, which performed a clinical audit to identify best practices and thereby improve and optimize radiotherapy delivery at those institutions [9].…”

Section: Introductionmentioning

confidence: 99%

Multicentre clinical radiotherapy audit in rectal cancer: results of the IROCA project

et al. 2020

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Purpose: To perform a clinical audit to assess adherence to standard clinical practice for the diagnosis, treatment, and follow-up of patients undergoing radiotherapy for rectal cancer treatment in four European countries. Materials and methods: Multi-institutional, retrospective cohort study of 221 patients treated for rectal cancer in 2015 at six European cancer centres. Clinical indicators applicable to general radiotherapy processes were evaluated. All data were obtained from electronic medical records. Results: The audits were performed in the year 2017. We found substantial inter-centre variability in adherence to standard clinical practices: 1) presentation of cases at departmental clinical sessions (range, 0-100%) or multidisciplinary tumour board (50-95%); 2) pretreatment MRI (61.5-100%) and thoracoabdominal CT (15.0-100%). Large inter-centre differences were observed in the mean interval between biopsy and first visit to the radiotherapy department (range, 21.6-58.6 days) and between the first visit and start of treatment (15.1-38.8 days). Treatment interruptions ≥ 1 day occurred in 43.9% (2.5-90%) of cases overall. Treatment compensation was performed in 2.1% of cases. Treatment was completed in the prescribed time in 55.7% of cases. Conclusions: This multi-institutional clinical audit revealed that most centres adhered to standard clinical practices for most of the radiotherapy processes-related variables assessed. However, the audit revealed marked inter-centre variability for certain quality indicators, particularly inconsistent record keeping. Multiple targets for improvement and/or harmonisation were identified, confirming the value of routine clinical audits to detect potential deviations from standard clinical practice.

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“…3 Standardization of evaluation and reporting of acute and late effects would be of a value not only for patients' benefit but also for the future studies and audits to prevent potential overreaction due to errors in irradiation. 13 In this study, we tested the PBL of relatively large group of patients during radiotherapy and chemoradiation. In line with other studies, we were not able to prove that assessment γ-H2AX with flow cytometry is a method ready to be used clinically for identification of patients with high risk for mucositis before or early during treatment.…”

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confidence: 99%

The kinetics of γ-H2AX during radiotherapy of head and neck cancer potentially allow for prediction of severe mucositis

Kaźmierska

Barczak

Winiecki

et al. 2020

Radiology and Oncology

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BackgroundThe aim of the study was to evaluate the changes in γ-H2AX expression in peripheral blood lymphocytes (PBL) according to severity of radiation-induced mucositis.Patients and methodFifty patients with head and neck cancer treated with radiotherapy (RT) or chemoradiation were included in the study. Blood samples were collected before treatment to measure baseline γ-H2AX levels. Second sample was taken 45 minutes after the first RT fraction and then once a week, 45 min after irradiation. In patients treated with chemoradiation the blood sample was taken the day after chemotherapy. Mucositis was evaluated once a week and reported according to CTCAE v4 and RTOG/EORTC scales. PBL were analyzed with flow cytometry and level of H2AX phosphorylation at every time point was evaluated.ResultsIn 35 patients mild to moderate (grade 1–2) mucositis was observed and 15 patients developed severe (grade 3) mucositis. No cases of grade 4 mucositis were observed. The difference in baseline levels of γ-H2AX between groups with mild and severe mucositis was statistically insignificant (p = 0.25). The statistically significant difference in γ-H2AX level was observed in week 7 of treatment (p = 0.01). No significant differences in γ-H2AX level were found neither between group treated with concomitant chemoradiation or RT alone neither between groups with and without common comorbidities. In the analysis of the kinetics of γ-H2AX during treatment, a statistically significant difference (p = 0.0088) between groups with mild and severe mucositis was observed. After fourth week of treatment levels of γ-H2AX decreased significantly in the group with severe mucositis and increased in patients with mild side effects. The observed difference was not caused by the decrease in peripheral lymphocyte count, which was similar in both groups.ConclusionsPresented results indicate that severity of radiation-induced mucositis does not correlate directly with γ-H2AX levels measured in vivo in PBL. Prediction of mucositis grade based on γ-H2AX level is not yet possible, either before treatment or early during treatment, but preliminary results, indicating significant differences in γ-H2AX kinetics between groups, encourage further studies.

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Improving radiation oncology through clinical audits: Introducing the IROCA project

Cited by 10 publications

References 19 publications

Results of the IROCA international clinical audit in prostate cancer radiotherapy at six comprehensive cancer centres

Results of the IROCA international clinical audit in prostate cancer radiotherapy at six comprehensive cancer centres

Multicentre clinical radiotherapy audit in rectal cancer: results of the IROCA project

The kinetics of γ-H2AX during radiotherapy of head and neck cancer potentially allow for prediction of severe mucositis

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