Internal Audit Of A Comprehensive IMRT Program For Prostate Cancer: A Model For Centers In Developing Countries?

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 26 May 2009 - 2:00 PDT

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UroToday.com - During the last economic boom of 2003-2007, cancer centers in second and third-tier countries across the globe made significant investments in radiotherapy infrastructure, acquiring state-of-the-art technologies such as intensity modulated radiotherapy, image-guided radiotherapy, proton therapy and stereotactic radiotherapy, to mention a few. This rapid expansion was partly brought on by competition in the burgeoning global medical tourism industry, and partly by the availability of easy credit, the hallmark of the last economic expansion and the current calamitous downturn.

Competition in medical tourism is particularly acute in Asia, where estimates of revenue are of at least USD$4 billion by 2012 in this region alone. In 2007, Asia represented 12.7% of the global medical tourism market with 2.9 million patients and generated revenues of USD$3.4 billion. Reasons for this growing industry include improvements in medical standards, growing prosperity, comparatively weaker Asian currencies (and hence greater affordability), and convenient international travel. The current major players in Southeast Asia include Thailand, India, Singapore and Malaysia. Yet little has been published about the implementation of adequate quality assurance and safeguards in all aspects of patient management, especially with cutting-edge equipment. Thus, this study was designed to illustrate the quality assurance steps that were taken at the National University Hospital (NUH), a tertiary cancer center in Singapore.

Intensity-modulated radiotherapy (IMRT), an advanced form of radiotherapy delivery that achieves highly conformal radiation, is widely practiced in Western countries. At NUH, it was carefully introduced into clinical practice in 2005. A number of quality assurance steps were introduced in their process. This study focused on the dosimetric quality assurance, i.e., did the radiotherapy treatment plans achieve the pre-defined 18 dose objectives for prostate cancer.

From 2005 to 2008, 76 patients with prostate cancer received IMRT, representing 1,140 evaluable dosimetric endpoints. Of these 1,140 endpoints, only 3% failed to meet the protocol criteria. At the weekly departmental quality assurance rounds, none of the plans were deemed to have a major protocol violation. Among these 76 patients, there were 2 cases each of acute and late grade 3-4 toxicities.

In summary, the proposed comprehensive, practice-adapted quality assurance measures hopefully serve as a model for other cancer centers contemplating the development of an IMRT program.

Written by Hans T. Chung, MD, FRCPC*, and Ping Xia, PhD** as part of Beyond the Abstract on UroToday.com

* Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
** Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH.

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