AIM

Data from 1st December 2013 to 28th February 2014 was analysed on a

site specific basis from all 50 English centres currently feed information

into the RTDS. Any treatment delivered using VMAT is coded as IMRT.

IMRT delivery within the RTDS is defined as:

The Radiotherapy Board

NATCANSAT National Clinical Analysis and

Specialised Applications Team

www.natcansat.nhs.uk

John Staffurth1, Tracey Ellison2, Chris Ball2 & Gerry Hanna3 1Institute of Cancer and Genetics, Cardiff University, Velindre Cancer Centre, Cardiff, CF14 2TL

2NATCANSAT, The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, Merseyside, CH63 4JY 3Centre for Cancer Research & Cell Biology, Queen’s University Belfast, Belfast, BT9 7BL

Patterns of IMRT delivery in England

To describe the usage of inverse planned IMRT usage across the 50

registered NHS radiotherapy centres in England during 2014 using the

National Radiotherapy Dataset, RTDS.

National guidance in 2009 from the National Radiotherapy

Implementation Group recommended that 33% of all radical radiotherapy

treatments should be delivered with IMRT and 24% with inverse planned

IMRT1. These figures were based on the treatment demographics from a

limited number of centres and expert opinion on the proportion of each

tumour sites that might benefit from IMRT. In 2011 the Commissioning for

Quality and Innovation set an incentive as part of the National Cancer

Plan2 improving cancer outcomes, to increase the uptake of IMRT.

Previous work has reported the access rates to IMRT across the UK, but

site specific data has been limited3, 4. An analysis of RTDS data was

undertaken to assess variation in global and site specific usage of IMRT

across the 50 English NHS radiotherapy centres in 2014. This has been

used to guide centres’ on their future estimation IMRT usage5.

The national usage of inverse planned IMRT is now over 36%, with only

two centres failing to meet the 24% target. Site specific targets were not

set and this may explain the wide range in usage between centres. The

variation is least for prostate and H&N cancers. These have the greatest

evidence base and there have been multi-centre IMRT trials supported by

the NCRI RTTQA group (http://ctrad.ncri.org.uk/research-support/quality-

assurance-support). IMRT trials in the other tumours are occurring, so

variations are expected to reduce.

REFERENCES

1 Intensity Modulated Radiotherapy (IMRT) A Guide for Commissioners. An NRIG Technology sub-group Report - November 2009.

http://connect.qualityincare.org/__data/assets/pdf_file/0004/554179/NHS_guidelines_on_IMRT.pdf

2 Improving Outcomes: A Strategy for Cancer DOH 2011

3 Survey of the availability and use of advanced radiotherapy technology in the UK. Mayles WPM on behalf of the Radiotherapy

Development Board. Clin Oncol (R Coll Radiol). 2010 Oct;22(8):636-642

4 Progress with intensity-modulated radiotherapy implementation in the UK. Mayles WP, Cooper T, Mackay R, Staffurth J, Williams

M. Clin Oncol (R Coll Radiol). 2012 Oct; 24(8): 543-544

5 Intensity Modulated Radiotherapy (IMRT) in the UK: Current access and predictions of future access rates. Staffurth J, Ball C,

Hanna G, Ellison T, Rowbottom C on behalf of the Radiotherapy Board.

http://www.ipem.ac.uk/Portals/0/Documents/Partners/Radiotherapy%20Board/imrt_target_revisions_recommendations_for_colleges_final2.

pdf

IMRT Delivery by

Radiotherapy Provider

Numerator: The number of (new) unique patients starting radiotherapy with inverse planned IMRT (excluding breast radiotherapy) within the specified month. Denominator: The number of (new) radical episodes starting radiotherapy including breast cancer (C50); excluding brachytherapy and patients with a diagnosis of non melanoma skin, (C44) within the specified month.

The Radiotherapy Board was set up in April 2013 and provides guidance,

oversight and support for the continuing development of high-quality

radiotherapy services for cancer patients across the 4 devolved nations.

https://www.rcr.ac.uk/clinical-oncology/faculty-structure/radiotherapy-board

IMRT usage across

England 2012-2014: All centres/ all tumours

There was a marked variation in usage of IMRT between centres for

every tumour site except prostate cancer (between 0 and 100%). Usage

is highest for prostate and H&N cancer. Further details are available in

the Radiotherapy Board’s report5.

17157 radical treatments were delivered of which 6226 (36%) were

delivered by IMRT. Two centres remain below the 24% rate in Feb 2015,

compared to 4 in Feb 2014).

*

Prostate cancer; NRIG target: 80% Head and neck; NRIG target: 80%

CNS tumours; target: 60% Gynaecological; target: 20% Breast cancer; target: 0%

Lung cancer; No target Upper GI cancers; No target Rectal cancer; No target

Anal cancer; No target Bladder cancer; No target Sarcomas; No target

*Forward-planned breast IMRT is not considered as an IMRT type treatment, any inverse-

planned breast treatment or a forward planned breast IMRT plan with patient specific QA IS

included in the IMRT numbers.

BACKGROUND

METHODS

RESULTS – All tumour sites

RESULTS – Site specific usage

DISCUSSION