Improving delivery of PORT in head and neck cancer patients at North Middlesex Hospital

NMUH Staff Publications

EMBASE

29

<span style="font-size: 10pt;">Background to the audit: Postoperative radiotherapy has long been used in head and neck cancer to improve loco regional control and survival following tumour resection.[2],[3],[4] Having established the benefit of PORT the timing is also important. This has been reviewed in a study looking at overall treatment time's effect on loco regional control.[1] Showing patients completing their treatment within 11 weeks had better loco regional control and survival rates. A prolongation in overall treatment time (often due to post-surgical healing) to more than 13 weeks had a detrimental effect on loco-regional control and survival rates. With results for the intermediate group, 11-13 weeks, lying in between. Standard: 3 standards were set 1. Surgery to start of radiotherapy six weeks (42 days) - this was set using the BAHNO guidelines for oral cavity cancers and is the national accepted practice for other sub sites.[5] This correlates to an overall treatment time of 12 weeks if a six week fractionation is used (84 days).[5] 2. ECAD (earliest clinically appropriate date) to radiotherapy start date (31 days) - this is a national cancer waiting time (CWT) breach target.[6] 3. Overall treatment time (from surgery to completion of radiotherapy) - at least <13 weeks (91 days) but at best and where we should be aiming <11 weeks (77 days). Indicator: The proportion of patients suitable for PORT and completing their treatment within 13 weeks. Target: 100% of patients should be receiving PORT within 13 weeks. Methodology: All patients receiving PORT using intensity-modulated radiotherapy (IMRT) from July 2013 to January 2016. Data was collected on operation date, ECAD date, radiotherapy start date and overall treatment time. Results of first audit round: 39 patients for analysis. 56% of patients met the target of 13 weeks. 10% were treated within 11 weeks. There was a wide variation in overall treatment time (OTT) 48-148 days. First action plan: 1. Aim to see all post-operative patients within two weeks of surgery. 2. Trial of seeing patients who are likely to need radiotherapy preoperatively. 3. Aim to start radiotherapy six weeks after surgery. 4. Dental extractions at the time of surgery. 5. Aim to have a dedicated scanning slot each week for postoperative patients. 6. Aim to volume and plan within 2 weeks. [Conference abstract]</span>