2457 - Improving Quality in Radiation Oncology Using Clinical Audits - Results of Round 3 of the IROCA Project
Presenter(s)
M. Fundowicz1, C. Lopes de Castro2, C. Muñoz Montplet3, S. Curcean4, O. F. Coza5, J. Lencart2, L. Pinto2, M. Krengli6, F. Pierfrancesco7, C. Llacer8, M. Kruszyna- Mochalska9, E. Konstanty9, F. Guedea10, and J. Malicki11; 1Greater Poland Cancer Centre, Poznan, Poland, 2Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal, 3Catalan Institute of Oncology, Girona, Spain, 4Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania, 5Oncology Institute "Prof. Ion Chiricuta, Cluj-Napoca, Romania, 6University of Piemonte Orientale, Novara, Italy, 7Department of Radiation Oncology, University Hospital "Maggiore della Carità", Novara, Italy, 8Montpellier Cancer Institute, Montpellier, France, 9Department of Medical Physics, Greater Poland Cancer Centre, Poznan, Poland, 10Catalan Institute of Oncology, Barcelona, Spain, 11Department of Electroradiology, Poznan University of Medical Sciences, Poznan, Poland
Purpose/Objective(s):
The aim of the study was to (1) evaluate adherence to a consensus-based core set of quality indicators and to compare participating institutions in order to identify best practices and (2) compare the obtained results to the ones received for the previous similar study. Materials/Methods: IROCA (Improving Quality in Radiation Oncology through Clinical Audits) is a collaborative project involving in six European radiotherapy departments from comprehensive cancer centers, allowing to assess (using clinical audit|) clinical protocols and identifying deviations from good clinical practice. The IROCA project focused on radiotherapy for rectal, prostate and breast (beginning round 4) cancers. Three rounds of IROCA have been completed and round 4 has been launched in 2026. Here we report results of round 3. The methods included a retrospective review of medical records of patients treated in 2018-2019, including clinical, diagnostic, dosimetry and technical data, for up to 100 patients per tumor site (rectal and prostate cancer) at each participating center. A comparison to the previous round 2 (patients treated in whole year 2015) was done. Patient records were randomly selected with predefined inclusion criteria. All data were anonymized and entered into a central database. The audit process consisted of several steps: obtaining ethical approvals and establishing data protection protocols; identifying key elements of the radiotherapy process and selecting relevant quality indicators; conducting external clinical audits in participating centers in line with European Commission guidelines, data collection via a dedicated online database and statistical analysis followed by publication of results.Results:
At round 3 we evaluated records for 556 patients with rectal cancer and 489 with prostate cancer, while in round 221 and 240 respectively. Pre-treatment pelvic MRI was performed in 90.7% of rectal cancer cases and 83.5% of prostate cancer cases. Departmental clinical session were documented in 76.8% and multidisciplinary tumor board 92.3% of rectal cancer cases. Most patients were referred from external hospitals. Clinical trial participation was recorded in 7.7% of rectal and 15.2% of prostate cancer patients. Most patients in rectal cancer were treated with VMAT (38.1%), IMRT (34,2%), 3DCRT (15,1%). The mean interval between the first visit and initiation of radiotherapy was 28.7 days. Comparison to the round 2: for all indicators describing the performance of radiotherapy departments the improvement was noted, although for some the assumed target values were not reached.Conclusion:
This multi-institutional audit showed variability in clinical practice among participating centers, while overall adherence to good clinical practice remained high. The results highlighted areas for targeted improvement and confirmed the value of international clinical audits in identifying both deviations from standards and transferable best practices.