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2. Radiotherapy for Prostate Cancer: is it ‘what you do’ or ‘the way that you do it’? A UK Perspective on Technique and Quality Assurance

Author

Emma L Turner, Catherine Brewer, Selina Bhattarai, Fritz Schroeder, Rosemary Currer, Anna Dimes, Liz Salter, Helen Taylor, Donna Johnson, Lynda Penketh, Tony Geater, Elizabeth Wyber, Dominic Ash, Alastair Innes, Richard Benson, Sharon Atkinson, Briony Tomkies, Christy Walker, Sharon Williams, Paula Wilson, Jane Drew, Julie Needham, Malcolm David Mason, Nicola Dixon, Aileen MacLeod, Nick Early, David J. Griffiths, Neeta Deshmukh, Penny Ebbs, Alex Martin, John Lilley, John Graham, Geraint Lewis, Ken Grigor, David E. Neal, Chris Sully, Susan Dark, Edgar Paez, Roger Kocklebergh, Eleanor I Walsh, Peter C. Albertsen, Ayesha Williams, Vicky Taylor, Lucy Wills, Caroline Sutton, Tanya Liddiatt, Rose Donohue, Michael Davis, Collette Grant, Carol Torrington, Lisa Geoghegan, Gill Davis, Simon Russell, Elizabeth Bellis-Sheldon, Chantal Bougard, Michelle Purdie, Claire Ward, Alan McNeill, Lynda Goddall, Sarah Askew, Helen Hunt, Sian Noble, Angus Robinson, Sarah Hawkins, Andrew Harvey, Gill Lawrence, Jane Denizot, Jainee Mauree, Adrian Grant, Jackie Mutch, Jennie Charlton, John Townley, Sharon Holling, Chris Herbert, Jill Ferguson, Susan Moore, Carmel Loughrey, Mandy Le Butt, Alan Doherty, Susie Hall, Lucy Brindle, Liza Jones, Michael Sokhal, O. Woodley, Carole Stenton, Hartwig Schwaibold, Amit Bahl, Pippa Taggart, Claire Heymann, Jean Haddow, Tim O'Brien, Prasad Bollina, Steven Bolton, James W.F. Catto, Philip Powell, Jonathan Aning, Norma Lyons, Lynne Smith, Janet Roxburgh, John Conway, Elizabeth Down, Malee Fernando, Sean Bryne, Hanan Khazragui, Jo Leworthy, Howard Kynaston, Neil Roberts, Tonia Adam, D. J. Smith, John R. Goepel, Killian Mellon, Stephen Slade, Joanne Bowtell, Nicholas D. James, Marie Tiffany, Louise Mellen, Jo Bythem, Susan Lamb, Hilary Taylor, Gill Delaney, Deborah Ashby, Duncan McClaren, James N'Dow, Barbara Hattrick, Tricia O'Sullivan, Chris Burton, James Swinscoe, Lindsay Robson, Raj Persad, Christine Croker, Alan Paul, David N. Tulloch, Kathleen Parker, D J Dedman, Belle Harris, Jenny Clarke, Tracy E Roberts, Janet Potterton, Alison Grant, Joyce Wilkinson, Susan Coull, Param Mariappan, Fiona Marshall, Pauline Massey, Christopher Pawsey, Kevin Pearse, Graham Howard, Catherine Gray, Claire Plumb, Anna Pisa, Susan Halpin, Joanne Howson, Sue Kilner, Nick Mayer, Jenny Cloete, Jenny L Donovan, Lorraine Williams, Peter Holding, Susan Baker, Helen Patterson, Ingrid Emmerson, Nicola Trewick, Narottam Thanvi, Richard A. Moore, Derek J. Rosario, P. Symonds, Stephen Prescott, Lynne Bradshaw, Nikki Samuel, Alasdair Steele, Chloe Hoult, Sharon Holmes, Rebecca Farmer, Mark Beresford, C.L. Ferguson, Graham Chalmers, Hilary Moody, Rebecca Clark, Anthony L. Zietman, Sally Napier, Tom Steuart-Feilding, Mandy Jones, Viv Breen, Irene Sharkey, Chris Metcalfe, Gill Moulam, John Dormer, Rollo Moore, Nicholas Christoforou, Claire Daisey, Andrew Doble, Sue Yarrow, David Gillatt, Liz Hart, Louise Goodwin, Richard A Cowan, Ayesha Thomas, Pippa Herbert, Carole Brain, Debbie Cooper, Sarah Brunt, Elliw Richards, G. Jones, Geoff Lambert, Helen Showler, Anthony Kouparis, Michael Wallace, Jon Oxley, Jan Adolfson, Michael Baum, Susan Fry, Alison McQueen, Jo Treeby, Tim Baynes, Elspeth Dewhurst, Dean Aston, Garett Durkan, Andrea Moore, T Lennon, Anne Y. Warren, J.N. Staffurth, Sarah Tidball, David P. Dearnaley, Alastair Law, Freddie C. Hamdy, M.C. Robinson, Emma Elliott, Zoe Wilkins, Ali Gadd, Peter Fayers, Owen Hughes, Sue Bonnington, Vicky Jackson, Michael Slater, John Staffurth, Murali Varma, G. Lewis, Mark Rees, Ian Roberts, Deborah Hicks, Tim J Peters, Edward Rowe, Jan Blaikie, C.R.J. Woodhouse, Helen Appleby, Teresa Robson, Ian Pedley, Hing Y. Leung, Alex Hale, Pauline Thompson, Andrea Wilson, Rachael De La Rue, Rosemary Godfrey, Subramaniam Vasanthan, J A Lane, and Julia Wade

Subjects
Male, medicine.medical_specialty, Quality Assurance, Health Care, medicine.medical_treatment, Planning target volume, quality assurance, randomised controlled trials, BTC (Bristol Trials Centre), Dose constraints, 03 medical and health sciences, Prostate cancer, 0302 clinical medicine, Prostate, Surveys and Questionnaires, Dose escalation, Humans, Medicine, Radiology, Nuclear Medicine and imaging, Medical physics, 030212 general & internal medicine, radiotherapy, Retrospective Studies, Clinical Trials as Topic, business.industry, Active monitoring, Prostatic Neoplasms, medicine.disease, Radiation therapy, medicine.anatomical_structure, Oncology, Centre for Surgical Research, 030220 oncology & carcinogenesis, Radiation Oncology, Physical therapy, BRTC, Radiotherapy, Conformal, business, Quality assurance
Abstract

Aims: The treatment of prostate cancer has evolved markedly over the last 40 years, including radiotherapy, notably with escalated dose and targeting. However, the optimal treatment for localised disease has not been established in comparative randomised trials. The aim of this article is to describe the history ofprostate radiotherapy trials, including their quality assurance processes, and to compare these with the ProtecT trial.Materials and methods: The UK ProtecT randomised trial compares external beam conformal radiotherapy, surgery and active monitoring for clinically localized prostate cancer and will report on the primary outcome (disease-specific mortality) in 2016 following recruitment between 1999 and 2009. The embedded quality assurance programme consists of on-site machine dosimetry at the nine trial centres, a retrospective review of outlining and adherence to dose constraints based on the trial protocol in 54 participants (randomly selected, around 10% of the total randomised to radiotherapy, n ¼ 545). These quality assurance processes and results were compared with prostate radiotherapy trials of a comparable era.Results: There has been an increasingly sophisticated quality assurance programme in UK prostate radiotherapy trials over the last 15 years, reflecting dose escalation and treatment complexity. In ProtecT, machine dosimetry results were comparable between trial centres and with the UK RT01 trial. The outliningreview showed that most deviations were clinically acceptable, although three (1.4%) may have been of clinical significance and were related to outlining of theprostate. Seminal vesicle outlining varied, possibly due to several prostate trials running concurrently with different protocols. Adherence to dose constraints inProtecT was considered acceptable, with 80% of randomised participants having two or less deviations and planning target volume coverage was excellent.Conclusion: The ProtecT trial quality assurance results were satisfactory and comparable with trials of its era. Future trials should aim to standardise treatment protocols and quality assurance programmes where possible to reduce complexities for centres involved in multiple trials. 2016 Published by Elsevier Ltd on behalf of The Royal College of Radiologists.

Published
2016

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