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Radiation Oncology
Published in: Radiation Oncology 1/2022

Open Access 01-12-2022 | Breast Cancer | Research

Transparency in quality of radiotherapy for breast cancer in the Netherlands: a national registration of radiotherapy-parameters

Authors: Nansi Maliko, Marcel R. Stam, Liesbeth J. Boersma, Marie-Jeanne T. F. D. Vrancken Peeters, Michel W. J. M. Wouters, Eline KleinJan, Maurice Mulder, Marion Essers, Coen W. Hurkmans, Nina Bijker

Published in: Radiation Oncology | Issue 1/2022

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Abstract

Background

Radiotherapy (RT) is part of the curative treatment of approximately 70% of breast cancer (BC) patients. Wide practice variation has been reported in RT dose, fractionation and its treatment planning for BC. To decrease this practice variation, it is essential to first gain insight into the current variation in RT treatment between institutes. This paper describes the development of the NABON Breast Cancer Audit-Radiotherapy (NBCA-R), a structural nationwide registry of BC RT data of all BC patients treated with at least surgery and RT.

Methods

A working group consisting of representatives of the BC Platform of the Dutch Radiotherapy Society selected a set of dose volume parameters deemed to be surrogate outcome parameters, both for tumour control and toxicity. Two pilot studies were carried out in six RT institutes. In the first pilot study, data were manually entered into a secured web-based system. In the second pilot study, an automatic Digital Imaging and Communications in Medicine (DICOM) RT upload module was created and tested.

Results

The NBCA-R dataset was created by selecting RT parameters describing given dose, target volumes, coverage and homogeneity, and dose to organs at risk (OAR). Entering the data was made mandatory for all Dutch RT departments. In the first pilot study (N = 1093), quite some variation was already detected. Application of partial breast irradiation varied from 0 to 17% between the 6 institutes and boost to the tumour bed from 26.5 to 70.2%. For patients treated to the left breast or chest wall only, the average mean heart dose (MHD) varied from 0.80 to 1.82 Gy; for patients treated to the breast/chest wall only, the average mean lung dose (MLD) varied from 2.06 to 3.3 Gy. In the second pilot study 6 departments implemented the DICOM-RT upload module in daily practice. Anonymised data will be available for researchers via a FAIR (Findable, Accessible, Interoperable, Reusable) framework.

Conclusions

We have developed a set of RT parameters and implemented registration for all Dutch BC patients. With the use of an automated upload module registration burden will be minimized. Based on the data in the NBCA-R analyses of the practice variation will be done, with the ultimate aim to improve quality of BC RT.
Trial registration Retrospectively registered.
Appendix
Available only for authorised users
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Metadata
Title
Transparency in quality of radiotherapy for breast cancer in the Netherlands: a national registration of radiotherapy-parameters
Authors
Nansi Maliko
Marcel R. Stam
Liesbeth J. Boersma
Marie-Jeanne T. F. D. Vrancken Peeters
Michel W. J. M. Wouters
Eline KleinJan
Maurice Mulder
Marion Essers
Coen W. Hurkmans
Nina Bijker
Publication date
01-12-2022
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2022
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-022-02043-0

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