Radiotherapy for Prostate Cancer

is it 'what you do' or 'the way that you do it'? A UK Perspective on Technique and Quality Assurance

M. D. Mason*, R. Moore, G. Jones, G. Lewis, J. L. Donovan, D. E. Neal, F. C. Hamdy, J. A. Lane, J. N. Staffurth, Sue Bonnington, Lynne Bradshaw, Debbie Cooper, Emma Elliott, Pippa Herbert, Peter Holding, Joanne Howson, Mandy Jones, Teresa Lennon, Norma Lyons, Hilary Moody & 231 others Claire Plumb, Tricia O'Sullivan, Liz Salter, Sarah Tidball, Pauline Thompson, Tonia Adam, Sarah Askew, Sharon Atkinson, Tim Baynes, Jan Blaikie, Carole Brain, Viv Breen, Sarah Brunt, Sean Bryne, Jo Bythem, Jenny Clarke, Jenny Cloete, Susan Dark, Gill Davis, Rachael De La Rue, Jane Denizot, Elspeth Dewhurst, Anna Dimes, Nicola Dixon, Penny Ebbs, Ingrid Emmerson, Jill Ferguson, Ali Gadd, Lisa Geoghegan, Alison Grant, Collette Grant, Catherine Gray, Rosemary Godfrey, Louise Goodwin, Susie Hall, Liz Hart, Andrew Harvey, Chloe Hoult, Sarah Hawkins, Sharon Holling, Alastair Innes, Sue Kilner, Fiona Marshall, Louise Mellen, Andrea Moore, Sally Napier, Julie Needham, Kevin Pearse, Anna Pisa, Mark Rees, Elliw Richards, Lindsay Robson, Janet Roxburgh, Nikki Samuel, Irene Sharkey, Michael Slater, Donna Smith, Pippa Taggart, Helen Taylor, Vicky Taylor, Ayesha Thomas, Briony Tomkies, Nicola Trewick, Claire Ward, Christy Walker, Ayesha Williams, Colin Woodhouse, Elizabeth Wyber, Jonathan Aning, Prasad Bollina, Jim Catto, Andrew Doble, Alan Doherty, Garett Durkan, David Gillatt, Owen Hughes, Roger Kocklebergh, Anthony Kouparis, Howard Kynaston, Hing Leung, Param Mariappan, Alan McNeill, Edgar Paez, Alan Paul, Raj Persad, Philip Powell, Stephen Prescott, Derek Rosario, Edward Rowe, Hartwig Schwaibold, David Tulloch, Mike Wallace, Amit Bahl, Richard Benson, Mark Beresford, Catherine Ferguson, John Graham, Chris Herbert, Graham Howard, Nick James, Alastair Law, Carmel Loughrey, Malcolm Mason, Duncan McClaren, Helen Patterson, Ian Pedley, Angus Robinson, Simon Russell, John Staffurth, Paul Symonds, Narottam Thanvi, Subramaniam Vasanthan, Paula Wilson, Helen Appleby, Dominic Ash, Dean Aston, Steven Bolton, Graham Chalmers, John Conway, Nick Early, Tony Geater, Lynda Goddall, Claire Heymann, Deborah Hicks, Liza Jones, Susan Lamb, Geoff Lambert, Gill Lawrence, Geraint Lewis, John Lilley, Aileen MacLeod, Pauline Massey, Alison McQueen, Rollo Moore, Lynda Penketh, Janet Potterton, Neil Roberts, Helen Showler, Stephen Slade, Alasdair Steele, James Swinscoe, Marie Tiffany, John Townley, Jo Treeby, Joyce Wilkinson, Lorraine Williams, Lucy Wills, Owain Woodley, Sue Yarrow, Selina Bhattarai, Neeta Deshmukh, John Dormer, Malee Fernando, John Goepel, David Griffiths, Ken Grigor, Nick Mayer, Jon Oxley, Mary Robinson, Murali Varma, Anne Warren, Lucy Brindle, Michael Davis, Dan Dedman, Elizabeth Down, Hanan Khazragui, Chris Metcalfe, Sian Noble, Tim Peters, Hilary Taylor, Emma Turner, Julia Wade, Eleanor Walsh, Susan Baker, Elizabeth Bellis-Sheldon, Chantal Bougard, Joanne Bowtell, Catherine Brewer, Chris Burton, Jennie Charlton, Nicholas Christoforou, Rebecca Clark, Susan Coull, Christine Croker, Rosemary Currer, Claire Daisey, Gill Delaney, Rose Donohue, Jane Drew, Rebecca Farmer, Susan Fry, Jean Haddow, Alex Hale, Susan Halpin, Belle Harris, Barbara Hattrick, Sharon Holmes, Helen Hunt, Vicky Jackson, Donna Johnson, Mandy Le Butt, Jo Leworthy, Tanya Liddiatt, Alex Martin, Jainee Mauree, Susan Moore, Gill Moulam, Jackie Mutch, Kathleen Parker, Christopher Pawsey, Michelle Purdie, Teresa Robson, Lynne Smith, Carole Stenton, Tom Steuart-Feilding, Chris Sully, Caroline Sutton, Carol Torrington, Zoe Wilkins, Sharon Williams, Andrea Wilson, Adrian Grant, Ian Roberts, Deborah Ashby, Richard Cowan, Peter Fayers, Killian Mellon, James N'Dow, Tim O'Brien, Michael Sokhal, ProtecT Study Group

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Citations (Scopus)

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 localised 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 = 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.

Original languageEnglish
Pages (from-to)e92-e100
Number of pages9
JournalClinical Oncology
Volume28
Issue number9
DOIs
Publication statusPublished - 1 Sep 2016

Keywords

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

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    Mason, M. D., Moore, R., Jones, G., Lewis, G., Donovan, J. L., Neal, D. E., ... ProtecT Study Group (2016). Radiotherapy for Prostate Cancer: is it 'what you do' or 'the way that you do it'? A UK Perspective on Technique and Quality Assurance. Clinical Oncology, 28(9), e92-e100. https://doi.org/10.1016/j.clon.2016.05.011