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

Malcolm D Mason, Rollo Moore, Geraint Lewis, Jenny Donovan, David E. Neal, Freddie C Hamdy, Athene Lane, John Staffurth, the ProtecT Study Group

Research output: Contribution to journalArticle (Academic Journal)peer-review

3 Citations (Scopus)
344 Downloads (Pure)

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 of
prostate 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 outlining
review showed that most deviations were clinically acceptable, although three (1.4%) may have been of clinical significance and were related to outlining of the
prostate. Seminal vesicle outlining varied, possibly due to several prostate trials running concurrently with different protocols. Adherence to dose constraints in
ProtecT 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.
Original languageEnglish
Pages (from-to)e92-e100
Number of pages9
JournalClinical Oncology
Volume28
Issue number9
Early online date11 Jun 2016
DOIs
Publication statusPublished - Sep 2016

Structured keywords

  • BTC (Bristol Trials Centre)
  • BRTC
  • Centre for Surgical Research

Keywords

  • Prostate cancer
  • quality assurance
  • radiotherapy
  • randomised controlled trials

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