Feasibility of Collecting Patient Reported Outcomes for Patients Receiving Curative Intent Rt for Gynecological Malignancies

CARO 2016 _________________________________________________________________________________________________________ was sent to all 14 provincial cancer centres in 2013. The survey included 72 questions in four different categories: general/demographic, pre-treatment assessment, EBRT and BT questions. Results: The response rate was 100%. Ten out of 14 centres treated cervical cancer patients and had a dedicated brachytherapy suite. All 10 centres that treated cervix cancer had a peer review process for quality assurance (QA). Nine centres had written treatment planning and delivery protocol and five centres used a specific plan evaluation protocol for organs at risk for EBRT. The standard EBRT technique was 4-field box in eight centres and one centre used IMRT if treating the para-aortic nodes simultaneously; one centre did not respond. The dose/fractionation scheme to the whole pelvis was 45-50 Gy in 1.8-2 Gy per fraction in all but one centre. Nine centres used image verification at some point during EBRT. All ten centres used HDR brachytherapy and one centre also used PDR brachytherapy to treat cervix cancer patients. Brachytherapy was performed under general anesthesia, regional anesthesia and conscious sedation in four, one and five centres, respectively. Only one centre offered interstitial brachytherapy. The majority of centres (eight of 10) used ultrasound image guidance for intrauterine applicator insertion. For treatment planning two centres used CT and MRI, four centres used CT only and four centres used orthogonal x-rays. GEC-ESTRO guidelines were used in three centres for target volume delineation and in five centres for organs at risk (OAR) dose constraints. Nine centres prescribed and reported dose to Point A. Volumetric dose prescription was performed in one centre and four centres reported dose to a target volume. Eight centres reported dose to OARs. The number of BT applicator insertions varied significantly between the centres ranging from one to six. The dose prescription was also variable ranging from 5.5 Gy to 8 Gy per fraction. Conclusions: The main findings from the survey were the variation in the BT dose fractionation and treatment planning used in the regional cancer centres while there was a general uniformity in peer reviewed QA, written institutional treatment protocol, EBRT technique, dose fractionation scheme and use of HDR BT across the province. This study shed light on the need to implement a harmonized evidence-based brachytherapy practice for cervical cancer in order to improve patients’ outcome across Ontario, Canada.