ESTRO 2024 - Abstract Book

S5889

RTT - Service evaluation, quality assurance and risk management

ESTRO 2024

(adjuvant) setting at an English NHS Provider starting between 1 January 2020 and 30 June 2022. The region code ‘Primary’ was used to identify treatments to the breast or chest wall only and the code ‘Primary and Regional Nodes’ was used for treatments additionally treating regional nodes.

Results:

Metric 1a

54,088 adjuvant radiotherapy episodes to breast or chest wall for invasive breast cancer (excluding patients receiving nodal treatment) were included. In the first half of 2020, 38% received 26 Gy in 5 fractions. This rose to 75% in the second half of 2020, with a further rise to 82% in January 2021 – June 2022.

Metric 1b

1,393 adjuvant radiotherapy episodes reporting treatment for DCIS were included. 37% received 26 Gy in 5 fractions in the first half of 2020. This rose to 88% in the second half of 2020, with a further rise to 94% in January 2021 – June 2022.

Metric 5

11,297 adjuvant breast boost episodes delivered to women under 50 for invasive breast cancer were included. In the first half of 2020, 53% underwent a boost. This increased to 57% in July 2020 – June 2022. There was wide variation between providers, ranging from 0% to 82% (median of 63%) in the latter period of January – June 2022.

Conclusion:

The 26 Gy in 5 fraction regimen was embedded in English NHS practice during 2020 following the publication of FAST Forward 4 , coinciding with the COVID-19 pandemic with rapid uptake of hypofractionation to reduce hospital footfall. Through discussion of results, providers with lower utilisation of 26Gy in 5 fractions have subsequently altered their clinical practice. Data quality issues relating to submitted ICD10 codes were identified with many providers submitting no episodes linked to the code D05. This has been discussed with providers both to support improvement in future submissions and understand the causes of variation in utilisation.

Metrics 2 - 4 will be assessed using RTDS v6.0 when available in 2024. Metric 6 analysis through ProKnow is currently underway.

As demonstrated in the RCR breast radiotherapy audits 1,10 , tumour bed boost remains an area of variation in England. This may be due to various individual patient factors, such as large breast size or the use of volume replacement oncoplastic breast techniques, which may increase tumour bed size, and the trade-off between local control and cosmesis 1 . Systematic variation between providers encourages providers to explore the possible causes for this. The results of this benchmarking exercise, shared through the radiotherapy networks, offer networks and providers a valuable insight into current breast radiotherapy practice in England. They encourage clinician engagement in reflective discussions to highlight areas for targeted quality improvement and greater standardisation across England.