An audit of dosefractionation schedules and timeliness of treatment Dr L Dixon and Dr J Wadsley Department of Clinical Oncology Weston Park Hospital Sheffield UK Background Chemoradiotherapy is a radical treatment option for patients with oesophageal cancer ID: 930409
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Slide1
RE-AUDIT Radical Chemo-Radiotherapy for Oesophageal Cancer:An audit of dose-fractionation schedules and timeliness of treatment
Dr L Dixon and Dr J WadsleyDepartment of Clinical Oncology, Weston Park Hospital, Sheffield, UK.
Slide2BackgroundChemo-radiotherapy is a radical treatment option for patients with oesophageal cancer. RCR guidelines1, include both squamous cell carcinoma and adenocarcinoma of the oesophagus as Category 1 tumour types.RCR Dose Fractionation Guidelines 200650.4Gy in 28 fractions, or 50Gy in 25 fractions.
Current local guidelines50Gy in 25 fractions.
Slide3AimsPrimary aim - to audit the timeliness and dose fractionation schedule of radical chemo-radiotherapy for oesophageal cancerSecondary aim - to assess the survival following treatment: median survival 1-year and 2-year overall survival
Initial Audit: 1st Sept 2004 – 31st Jan 2013Re-Audit: 1
st
Feb 2013 – 31
st
Jan 2015
Slide4StandardsMost patients should have dose fractionation schedules which comply with RCR guidelines2 At least 95% of patients should not have a prolongation of overall treatment time in excess of two days1 There is no possible standard for mortality figures.
Slide5MethodsRetrospective auditElectronic search identified patients treatedInitial Audit: 52 patients included
Re-audit: 17 patients includedAnalysis was performed using MS Excel and Kaplan-Meier survival was generated GraphPad Prism.
Slide6Demographics Age
Initial %
Re-audit
%
40-49
6
0
50-59
21
18
60-69
44
53
70-79
29
29
Sex
Male
52
35
Female
48
65
Histology
Squamous
89
82
Adenocarcinoma
11
18
Slide7Results – Initial AuditAchieved: 94% (49) received a dose fractionation schedules in accordance with RCR guidelines2.
These patients received 50Gy in 25#Not achieved: 85% (44) completed treatment without excessive prolongation of overall treatment timeMedian Survival 26.1 months
Overall 2-year survival 56%
Slide8Discussion – Initial AuditOverall Treatment Time8 (15%) patients had excessive prolongations7 patients - not treated on bank holidays1 patient - 5 day gap due to oesophageal stent insertion; gap calculation was performed to compensate (54Gy in 27#)
RCR guidance1 published December 2008Post Dec 2008 - 94% (30/32) had no prolongation in excess of two
days
2
patients - not treated bank
holidays
Both patients identified as Category 2 by clinician
Slide9Discussion – Initial AuditMedian survival: 26.1 months (range 4.1-101m)1-yr OS 69.2%, 2-yr OS 56
%
Survival comparable with the results of the SCOPE-1 trial
3
- radical chemo-radiotherapy +/-
Cetuximab
.
Chemo-radiotherapy
alone: Median
survival 25
months, 2-yr OS 56
%.
Slide10Re-AuditInitial results presented locally, to increase awareness regarding Category 1 status for all radically treatable oesophageal cancers. Education of medical staff and radiotherapy department regarding avoiding delays to treatment for Category 1 patients.Results presented nationally at RCR Clinical Oncology Audit Meeting 2014.
Slide11Results – Re-auditAchieved: 100% (17) received a dose fractionation schedules in accordance with RCR guidelines2.
These patients received 50Gy in 25#Achieved: 100% (17) completed treatment without excessive prolongation of overall treatment time
Slide12Discussion – Re-auditImprovement seen since initial audit and presentation to local departmentRe-education beneficial in helping to ensure patients identified correctly as category 1 treatment types. Both targets now achieved in re-audit
Slide13Possible Future PlansProject underway comparing outcomes between chemo-radiotherapy and radical radiotherapy aloneFurther re-audit to review progress and ensure standards are being maintained.Review survival – disease related or other causesReview tolerability of treatmentToxicity and long term effects
Slide14ConclusionChemo-radiotherapy remains a valid treatment option for oesophageal cancerSquamous cell and adenocarcinomas should both be treated as category 1 tumour types, with no excessive prolongations to overall treatment timeDose-fractionation schedules should be compliant with RCR Dose-Fractionation Guidelines1
Slide15ReferencesThe timely delivery of radical radiotherapy: standards and guidelines for the management of unscheduled treatment interruptions, Third edition, 01 December 2008. RCR Guidelines. RCR Dose Fractionation Guidelines, June 2006. Chemoradiotherapy with or without Cetuximab
in patients with oesophageal cancer (SCOPE1): a multicentre, phase 2/3 randomised trial. Crosby T, Hurt CN, Falk S, Gollins S, Mukherjee S, Staffurth J, Ray R, Bashir N, Bridgewater JA, Geh JI, Cunningham D, Blazeby
J, Roy R,
Maughan
T, Griffiths G. Lancet
Oncol
. 2013 Jun;14(7):627-37.
doi
: 10.1016/S1470-2045(13)70136-0.
Epub
2013 Apr 25.
Slide16Thank you