ESTRO 2024 - Abstract Book

S1615

Clinical - Lung

ESTRO 2024

As a single payer healthcare system, funded through taxation, the NHS aims to deliver high-quality care to all patients irrespective of where in the country they live and undergo treatment. The extent to which this is achieved in the delivery of radiotherapy (RT) for lung cancer is not known, but such information is crucial in supporting services optimising the care delivered. The National Disease Registration Service (NDRS) receives monthly submissions of standardised RT activity data which forms the Radiotherapy Data Set (RTDS). This routine collection of data provides the opportunity for consistent monitoring of radiotherapy across England. The Radiotherapy Transformation Programme within NHS England, in partnership with the NDRS, ProKnow Technical Oversight Group and tumour clinical specialist groups, has developed an innovative approach to identify, share and improve clinical practice using Quality Improvement Toolkits (QITs) consisting of clinical and dosimetry metrics within each tumour group. The lung RT clinical metrics, against which practice was assessed, were defined by a lung cancer clinical specialist group using the Royal College of Radiologists (RCR) consensus statements [1] and National Institute for Health and Care Excellence guideline [2]. Two metrics considered the use of intensity modulated RT (IMRT)/rotational IMRT in curative lung RT with the rationale being that IMRT/rotational IMRT improve conformality and minimise the dose delivered to surrounding normal tissues [1]. This was assessed separately for non-stereotactic (metric 1a) and stereotactic RT (metric 1b). Metric 2 examined the time interval between the decision to treat and treatment start date for curative lung RT, to support services in ensuring this interval is minimised to maximise treatment benefit [3]. Data was extracted from the RTDS for all curative intent external beam RT treatment episodes delivered at an English NHS Trust, starting between 1 January 2020 and 30 June 2022 and where the primary diagnosis ICD10 code was C33 or C34. Each of the metrics was calculated on data aggregated over six-month periods for each NHS trust. The OPCS Classification of Interventions and Procedures (OPCS-4) procedure codes (used for reimbursement and collection of coded treatment information) were used to identify if an episode utilised IMRT/rotational IMRT (OPCS-4 X67.1) or stereotactic radiotherapy (OPCS-4 Y91.5). We calculated the interval in days between the decision to treat date (DTT) or the earliest clinically appropriate date (ECAD), whichever was closer to the start of treatment, and the date of the first appointment of each lung RT episode. Material/Methods:

Results:

A total of 11,867 curative non-stereotactic lung RT episodes were included in the analysis. The national proportion of episodes delivered using IMRT/rotational IMRT increased from 77% in the first half of 2020 to 82% in the first half of 2022. In the first half of 2022, the range in the proportion across the NHS Trusts was between 27% and 100%, with a median of 90% (metric 1a) (Figure 1).