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Patterns of care study of brachytherapy in New South Wales: malignancies of the uterine corpus.

Thompson SR, Delaney GP, Gabriel GS, Barton MB - J Contemp Brachytherapy (2015)

Bottom Line: Higher gynaecological BT caseload departments were compared with lower caseload departments.The four higher gynaecological BT caseload departments treated a median of 25.5 NSW residents (range 22-38), compared to median 10 (range 3-18) in the five lower caseload departments.Doses prescribed may not be optimal in lower gynaecological BT caseload departments - the significance of this represents an area in which more research is needed.

View Article: PubMed Central - PubMed

Affiliation: Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Liverpool Hospital ; Department of Radiation Oncology, Prince of Wales Hospital ; University of New South Wales.

ABSTRACT

Purpose: There are limited data at a population level on adjuvant brachytherapy (BT) practice for uterine corpus malignancies. The aims of the current study were to describe BT practice for this disease in New South Wales (NSW), to assess quality of BT, and to determine if a caseload effect on quality exists.

Material and methods: Patient, tumour, and treatment related data were collected from all nine NSW radiation oncology departments that treated patients with BT. Included patients had malignancy of the uterine corpus with treatment including BT. Brachytherapy quality was assessed using published quality benchmarks. Higher gynaecological BT caseload departments were compared with lower caseload departments.

Results: One hundred sixty-three NSW residents with gynaecological cancer were treated with BT. The four higher gynaecological BT caseload departments treated a median of 25.5 NSW residents (range 22-38), compared to median 10 (range 3-18) in the five lower caseload departments. Seventy-five patients underwent BT for uterine malignancies. Most patients had early stage endometrioid disease and were treated adjuvantly with intravaginal cylinders using high-dose-rate BT. Doses were in accordance with guideline recommendations in 83% of cases, and BT was appropriately indicated in 76% of cases. Higher caseload departments were more likely to treat with guideline doses (96% vs. 53%, p < 0.001) but there was no difference in compliance rate with treatment indications (p = 0.75).

Conclusions: Brachytherapy patients, techniques, and numbers/unit for uterine corpus malignancies were similar in NSW compared to the USA but more dispersed than in Western Europe. Doses prescribed may not be optimal in lower gynaecological BT caseload departments - the significance of this represents an area in which more research is needed.

No MeSH data available.


Related in: MedlinePlus

Appropriateness of adjuvant brachytherapy indication, by departmental gynaecological brachytherapy caseload volume – stage I endometrioid adenocarcinoma of the uterus (p = 0.75). Appropriateness of brachytherapy indication was as recommended by New South Wales guidelines [5]
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Figure 0002: Appropriateness of adjuvant brachytherapy indication, by departmental gynaecological brachytherapy caseload volume – stage I endometrioid adenocarcinoma of the uterus (p = 0.75). Appropriateness of brachytherapy indication was as recommended by New South Wales guidelines [5]

Mentions: Treatment with adjuvant BT was scored as potentially inappropriate if delivered to patients with stage I disease without adverse pathological features (stage IC, lymphovascular invasion, grade 3, or close margins) giving an indication for adjuvant RT (BT with or without EBRT) (5): 8 of 34 cases (24%), with no significant difference by gynaecological BT caseload (p = 0.75) – Fig. 2.


Patterns of care study of brachytherapy in New South Wales: malignancies of the uterine corpus.

Thompson SR, Delaney GP, Gabriel GS, Barton MB - J Contemp Brachytherapy (2015)

Appropriateness of adjuvant brachytherapy indication, by departmental gynaecological brachytherapy caseload volume – stage I endometrioid adenocarcinoma of the uterus (p = 0.75). Appropriateness of brachytherapy indication was as recommended by New South Wales guidelines [5]
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499520&req=5

Figure 0002: Appropriateness of adjuvant brachytherapy indication, by departmental gynaecological brachytherapy caseload volume – stage I endometrioid adenocarcinoma of the uterus (p = 0.75). Appropriateness of brachytherapy indication was as recommended by New South Wales guidelines [5]
Mentions: Treatment with adjuvant BT was scored as potentially inappropriate if delivered to patients with stage I disease without adverse pathological features (stage IC, lymphovascular invasion, grade 3, or close margins) giving an indication for adjuvant RT (BT with or without EBRT) (5): 8 of 34 cases (24%), with no significant difference by gynaecological BT caseload (p = 0.75) – Fig. 2.

Bottom Line: Higher gynaecological BT caseload departments were compared with lower caseload departments.The four higher gynaecological BT caseload departments treated a median of 25.5 NSW residents (range 22-38), compared to median 10 (range 3-18) in the five lower caseload departments.Doses prescribed may not be optimal in lower gynaecological BT caseload departments - the significance of this represents an area in which more research is needed.

View Article: PubMed Central - PubMed

Affiliation: Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Liverpool Hospital ; Department of Radiation Oncology, Prince of Wales Hospital ; University of New South Wales.

ABSTRACT

Purpose: There are limited data at a population level on adjuvant brachytherapy (BT) practice for uterine corpus malignancies. The aims of the current study were to describe BT practice for this disease in New South Wales (NSW), to assess quality of BT, and to determine if a caseload effect on quality exists.

Material and methods: Patient, tumour, and treatment related data were collected from all nine NSW radiation oncology departments that treated patients with BT. Included patients had malignancy of the uterine corpus with treatment including BT. Brachytherapy quality was assessed using published quality benchmarks. Higher gynaecological BT caseload departments were compared with lower caseload departments.

Results: One hundred sixty-three NSW residents with gynaecological cancer were treated with BT. The four higher gynaecological BT caseload departments treated a median of 25.5 NSW residents (range 22-38), compared to median 10 (range 3-18) in the five lower caseload departments. Seventy-five patients underwent BT for uterine malignancies. Most patients had early stage endometrioid disease and were treated adjuvantly with intravaginal cylinders using high-dose-rate BT. Doses were in accordance with guideline recommendations in 83% of cases, and BT was appropriately indicated in 76% of cases. Higher caseload departments were more likely to treat with guideline doses (96% vs. 53%, p < 0.001) but there was no difference in compliance rate with treatment indications (p = 0.75).

Conclusions: Brachytherapy patients, techniques, and numbers/unit for uterine corpus malignancies were similar in NSW compared to the USA but more dispersed than in Western Europe. Doses prescribed may not be optimal in lower gynaecological BT caseload departments - the significance of this represents an area in which more research is needed.

No MeSH data available.


Related in: MedlinePlus