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Quality Control of Radiation Delivery for Lower Gastrointestinal Cancers

  • Lower Gastrointestinal Cancers (AB Benson, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Assessing the quality of health care delivered is a priority across medical specialties, but it is particularly critical for radiation oncology, a field with rapid introduction of new technologies and treatment paradigms. Deviation from acceptable standards can lead to delivery of inferior therapies and medical errors that can directly compromise patient clinical outcome, thus leading to disparities in quality of care. Professional oncologic specialty societies often take ownership of standardizing best practices by issuing evidence-based disease-specific consensus guidelines. They also inform quality indicators that are set as requirements for accreditation, maintenance of certification, and reimbursement. Cooperative groups also create benchmarks for quality radiation therapy through design of clinical protocols that set standard-of-care treatment practices. Pelvic radiotherapy for colorectal and anal cancers has undergone a significant transformation in radiation planning and delivery including increased complexity in contour segmentation with a transition from three-dimensional to intensity-modulated radiation therapy (IMRT). Compliance with quality metrics proposed in national consensus guidelines and participation in clinical trials help keep practicing radiation oncologists up-to-date with advances in our field and well-trained to provide safe and effective high-value care.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• National Comprehensive Cancer Network. Anal Carcinoma (Version 2.2017 – April 20, 2017). https://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf. The NCCN Clinical Practice Guidelines in Oncology are evidence-based management recommendations for diagnostic, preventive, and supportive care and treatment developed through expert consensus. These are continually reviewed and updated at least annually, with real-time updates for advancements that may change clinical practice standards.

  2. •• National Comprehensive Cancer Network. Colon Cancer (Version 2.2018 – March 14, 2018). https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf. The NCCN Clinical Practice Guidelines in Oncology are evidence-based management recommendations for diagnostic, preventive, and supportive care and treatment developed through expert consensus. These are continually reviewed and updated at least annually, with real-time updates for advancements that may change clinical practice standards.

  3. •• National Comprehensive Cancer Network. Rectal Cancer (Version I.2018 – March 14, 2018). https://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf. The NCCN Clinical Practice Guidelines in Oncology are evidence-based management recommendations for diagnostic, preventive, and supportive care and treatment developed through expert consensus. These are continually reviewed and updated at least annually, with real-time updates for advancements that may change clinical practice standards.

  4. Monson JRT, Weiser MR, Buie WD, Chang GJ, Rafferty JF, Buie WD, et al. Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum. 2013;56(5):535–50.

    Article  PubMed  CAS  Google Scholar 

  5. • Vogel JD, Eskicioglu C, Weiser MR, Feingold DL, Steele SR. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the treatment of colon cancer. Dis Colon Rectum. 2017;60(10):999–1017. https://doi.org/10.1097/DCR.0000000000000926. The American Society of Colon and Rectal Surgeons publishes evidence-based, expert committee written clinical practice guidelines for colorectal cancers. These guidelines define parameters for high-quality care.

    Article  PubMed  Google Scholar 

  6. Steele SR, Varma MG, Melton GB, Ross HM, Rafferty JF, Buie WD, et al. Practice parameters for anal squamous neoplasms. Dis Colon Rectum. 2012;55(7):735–49.

    Article  PubMed  Google Scholar 

  7. •• ACRO Accreditation Manual. July 2017. https://www.acro.org/wp-content/uploads/2016/05/ACRO ManualJuly2017.pdf. The ACRO Accreditation Manual outlines recommended criteria per disease site for each step of the treatment process (H&P, simulation, treatment-planning, treatment).

  8. Wo JY, Viswanathan AN. The impact of radiotherapy on fertility, pregnancy, and neonatal outcomes of female cancer patients. Int J Radiat Oncol Biol Phys. 2009;73(5):1304–12. https://doi.org/10.1016/j.ijrobp.2008.12.016.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Pregnancy After Cancer. c2018. Fort Washington (PA): National Comprehensive Cancer Network. https://www.nccn.org/patients/resources/life_after_cancer/pregnancy.aspx.

  10. Chen VE, et al. The impact of daily bladder filling on small bowel dose for intensity modulated radiation therapy for cervical cancer. Med Dosim.

  11. Scher ED, Ahmed I, Yue NJ, Jabbour SK. Technical aspects of radiation therapy for anal cancer. J Gastrointest Oncol. 2014;5(3):198–211. https://doi.org/10.3978/j.issn.2078-6891.2014.026.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Das IJ, Lanciano RM, Movsas B, Kagawa K, Barnes SJ. Efficacy of a belly board device with CT-simulation in reducing small bowel volume within pelvic irradiation fields. Int J Radiat Oncol Biol Phys. 1997;39:67–76.

    Article  PubMed  CAS  Google Scholar 

  13. Kim TH, Chie EK, Kim DY, Park SY, Cho KH, Jung KH, et al. Comparison of the belly board device method and the distended bladder method for reducing irradiated small bowel volumes in preoperative radiotherapy of rectal cancer patients. Int J Radiat Oncol Biol Phys. 2005;62:769–75.

    Article  PubMed  Google Scholar 

  14. Lee SH, Kim TH, Kim DY, et al. The effect of belly board location in rectal cancer patients treated with preoperative radiotherapy. Clin Oncol (R Coll Radiol). 2006;18:441–6.

    Article  Google Scholar 

  15. Myerson RJ, Garofalo MC, El Naqa I, et al. Elective clinical target volumes for conformal therapy in anorectal cancer: a radiation therapy oncology group consensus panel contouring atlas. Int J Radiat Oncol Biol Phys. 2009;74:824–30.

    Article  PubMed  Google Scholar 

  16. Ng M, Leong T, Chander S, Chu J, Kneebone A, Carroll S, et al. Australasian Gastrointestinal Trials Group (AGITG) contouring atlas and planning guidelines for intensity-modulated radiotherapy in anal cancer. Int J Radiat Oncol Biol Phys. 2012;83:1455–62.

    Article  PubMed  Google Scholar 

  17. Gay HA, Barthold HJ, O’Meara E, Bosch WR, el Naqa I, al-Lozi R, et al. Pelvic normal tissue contouring guidelines for radiation therapy: a radiation therapy oncology group consensus panel atlas. Int J Radiat Oncol Biol Phys. 2012;83(3):e353–62.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Goodman KA, Patton CE, Fisher GA, Hoffe SE, Haddock MG, Parikh PJ, et al. Appropriate customization of radiation therapy for stage II and III rectal cancer: executive summary of an ASTRO clinical practice statement using the RAND/UCLA appropriateness method. Pract Radiat Oncol. 2016;6(3):166–75.

    Article  PubMed  Google Scholar 

  19. Marks LB, Yorke ED, Jackson A, ten Haken RK, Constine LS, Eisbruch A, et al. Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys. 2010;76(3):S10–9.

  20. Kachnic LA, Winter K, Myerson RJ, Goodyear MD, Willins J, Esthappan J, et al. RTOG 0529: a phase II evaluation of dose-painted intensity modulated radiation therapy in combination with 5-fluorouracil and mitomycin-C for the reduction of acute morbidity in carcinoma of the anal canal. Int J Radiat Oncol Biol Phys. 2013;86(1):27–33.

  21. Hong TS, Moughan J, Garofalo MC, Bendell J, Berger AC, Oldenburg NBE, et al. NRG oncology radiation therapy oncology group 0822: a phase 2 study of preoperative chemoradiation therapy using intensity modulated radiation therapy in combination with capecitabine and oxaliplatin for patients with locally advanced rectal cancer. Int J Radiat Oncol Biol Phys. 2015;93(1):29–36.

  22. • Law E, et al. Prospective study of vaginal dilator use adherence and efficacy following radiotherapy. Radiother Oncol. 2015;116(1):149–55. This prospective trial analyzed adherence and efficacy of vaginal dilator use for patients receiving pelvic radiotherapy and was the first prospective study to demonstrate that vaginal dilator use was effective in minimizing vaginal stenosis for patients with anal and rectal cancers.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Bernard S, Ouellet MP, Moffet H, Roy JS, Dumoulin C. Effects of radiation therapy on the structure and function of the pelvic floor muscles of patients with cancer in the pelvic area: a systematic review. J Cancer Surviv. 2016;10(2):351–62.

    Article  PubMed  Google Scholar 

  24. Melvani R, et al. Who prescribes hormone replacement therapy for young women with radiation-induced premature ovarian failure? Int J Radiat Oncol Biol Phys. 2017;99(2):E302.

    Article  Google Scholar 

  25. Jain SK, Goodman KA. Gastrointestinal brachytherapy: anal and rectal cancer. In: Mayadev J, Benedict SH, Kamrava M, editors. Handbook of image-guided brachytherapy. Cham: Springer International Publishing; 2017. p. 289–318.

    Chapter  Google Scholar 

  26. Vuong T, Devic S, Podgorsak E. High dose rate endorectal brachytherapy as a neoadjuvant treatment for patients with resectable rectal cancer. Clin Oncol. 2007;19(9):701–5.

    Article  CAS  Google Scholar 

  27. Vuong T, Devic S. High-dose-rate pre-operative endorectal brachytherapy for patients with rectal cancer. J Contemp Brachytherapy. 2015;7(2):183–8. https://doi.org/10.5114/jcb.2015.51402.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Harrison LB, Minsky BD, Enker WE, Mychalczak B, Guillem J, Paty PB, et al. High dose rate intraoperative radiation therapy (HDR-IORT) as part of the management strategy for locally advanced primary and recurrent rectal cancer. Int J Radiat Oncol Biol Phys. 1998;42(2):325–30.

    Article  PubMed  CAS  Google Scholar 

  29. Hathout L, Williams T, Jabbour SK. The impact of novel radiation treatment techniques on toxicity and clinical outcomes in rectal cancer. Curr Colorectal Cancer Rep. 2017;13(1):61–72.

  30. Ohri N, Shen Z, Dicker AP, et al. Radiotherapy protocol deviations and clinical outcomes: a meta-analysis of cooperative group clinical trials. J Natl Cancer Inst. 2013;105(6):387–93.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  31. Halperin EC, Laurie F, Fitzgerald TJ. An evaluation of the relationship between the quality of prophylactic cranial radiotherapy in childhood acute leukemia and institutional experience: a quality assurance review center-pediatric oncology group study. Int J Radiat Oncol Biol Phys. 2002;53(4):1001–4.

    Article  PubMed  Google Scholar 

  32. Radiation Therapy Oncology Group (RTOG). RTOG 0848 Protocol Information. http://www.rtog.org/ClinicalTrials/ProtocolTable/StudyDetails.aspx?study=0848.

  33. Goodman KA. Quality assurance for radiotherapy: a priority for clinical trials. JNCI. 2013;105(6):376–7.

    Article  PubMed  Google Scholar 

  34. • Daly B, et al. Oncology clinical pathways: charting the landscape of pathway providers. J Oncol Pract. 2018;14(3):e194–200. This article uses the ASCO developed “Criteria for High-Quality Clinical Pathway” to evaluate oncology clinical pathways from six different vendors.

    Article  PubMed  Google Scholar 

  35. Albert JM, Das P. Quality indicators in radiation oncology. Int J Radiat Oncol Biol Phys. 2013;85(4):904–11.

    Article  PubMed  Google Scholar 

  36. Merit-based Incentive Payment System (MIPS). c2018. Arlington (VA). ASTRO. https://www.astro.org/MIPS/.

  37. ASTRO: Accreditation Program for Excellence – Safety and Quality for Radiation Oncology Practice. c2018. Arlington (VA). ASTRO. https://www.astro.org/Accreditation.aspx.

  38. Cotter GW, Dobelbower RR Jr. Radiation oncology practice accreditation: the American College of Radiation Oncology, practice accreditation program, guidelines and standards. Crit Rev Oncol Hematol. 2005;55(2):93–102.

    Article  PubMed  Google Scholar 

  39. Goodman KA, Khalid N, Kachnic LA, Minsky BD, Crozier C, Owen JB, et al. Quality research in radiation oncology (QRRO) analysis of clinical performance measures in the management of gastric cancer. Int J Radiat Oncol Biol Phys. 2013;85(2):355–62.

    Article  PubMed  Google Scholar 

  40. Fogh SE, Pope CH, Rosenthal SA, Conway PD, Hulick PR, Johnson JL, et al. American College of Radiology (ACR) radiation oncology practice accreditation: a pattern of change. Pract Radiat Oncol. 2016;6(5):e171–7.

    Article  PubMed  Google Scholar 

  41. •• Practice Parameters by Subspecialty. c2018. Reston (VA). ACR. https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards/Practice-Parameters-by-Subspecialty. The ACR has an extensive set of practice parameters for radiation oncology across a wide range of topics such as IMRT, IGRT, SBRT, physics for external-beam therapy, communication, informed consent, and the physician expert witness. These practice parameters are updated regularly based on review of current literature, expert opinion, open forum commentary, and formal consensus.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Colorado Cancer Center, University of Colorado School of Medicine, 1665 Aurora Court, Suite 1032 MS F706, Aurora, CO, 80045, USA

    Supriya Jain MD, MHS & Karyn A. Goodman MD, MS

Authors
  1. Supriya Jain MD, MHS
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  2. Karyn A. Goodman MD, MS
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Correspondence to Karyn A. Goodman MD, MS.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Lower Gastrointestinal Cancers

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Jain, S., Goodman, K.A. Quality Control of Radiation Delivery for Lower Gastrointestinal Cancers. Curr. Treat. Options in Oncol. 19, 51 (2018). https://doi.org/10.1007/s11864-018-0564-7

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  • DOI: https://doi.org/10.1007/s11864-018-0564-7

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