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Parotid sparing adaptive radiotherapy (PSART) is resource intensive to implement. Selection criteria for using ART and its impact on quality of life (QoL) is poorly reported. This has been addressed in our study.Patients planned for curative radiotherapy for Head Neck Cancers were recruited following informed consent in a prospective cohort study. PSART was planned if the mean dose to index parotid(s) increased by 2% from the baseline approved plan. To assess the resource requirements of PSART manpower and time required for treatment planning both for initial as well as PSART was documented. Patient reported QoL using QualiXeQLS and EORTC QLQ C30 and HN35 were obtained pre radiotherapy, and at 3 and 9 months post radiotherapy.Of the ninety patients accrued, 87 were evaluable. 45 (51%) received PSART based on the prespecified criteria. The average time spent in contouring (276 min versus 133 min) and treatment planning (293 min versus 108 min) were almost doubled when PSART was implemented. XeQoL scores at 3 months were significantly worse in those receiving PSART (mean 2.3 vs 1.2, p 0.002). Despite this, xerostomia related QoL recovered to near baseline scores by 9 months after receiving PSART.Implementation of PSART is resource intensive. The proposed cutoff for implementing PSART identifies a higher risk population that have worse xerostomia related quality of life. This study lays the foundation for a randomized trial to determine the efficacy of PSART on xerostomia related QoL.

IntroductionPeer review of target volume is recommended as an important step for ensuring high quality radiotherapy. The Royal College of Radiologists considers gynecological cancers as one of the sites where peer review of individual target volumes is required. We report results of an on-demand peer review system for gynecological cancers in our institute. MethodsPeer review was planned for gynecological cancer cases planned for curative intent radiotherapy. On demand peer review was conducted by two senior clinical oncologists specializing in gynecological cancers after segmentation was completed by junior clinical oncologists. Peer review discussions were recorded prospectively in an electronic database. In the present study, data of patients planned from radiotherapy between 15th September 2021 - September 2022 is audited. The compliance to the audit process, proportion of patients requiring major and minor modifications in target volumes, direction of changes noted as well as factors influencing the changes have been reported.ResultsIn the study period, 230 patients underwent planning for curative intent radiotherapy and 204 (88.3%) patients had at least one peer review. Major target volume changes were required in 108 patients, with the majority of changes reported in the nodal CTV. Analysis of P-charts showed a rapid change in proportion of patients requiring major modifications with stabilization at the end of 3 months to 38.2% and 28% for nodal and primary CTV respectively. Modifications were primarily required in the para-aortic and common iliac region for nodal CTV. Multivariable analysis showed that major modifications were associated with the use of extended field radiotherapy and use of radical radiation in non-cervical primaries. ConclusionAn on-demand peer review system was feasible and resulted in clinically meaningful changes in 53% of patients.

IntroductionThe COVID-19 pandemic has affected cancer care worldwide. We audited adherence to 19 predefined quality indicators (QI) of treatment in patients with carcinoma cervix in our institute. MethodsPatients with carcinoma cervix treated with curative intent radical radiotherapy were eligible for this study. Patients who started treatment between 24 March 2019 and 24 March 2021 were evaluated. We divided participants into two groups, the pre pandemic period between 24 March 2019 and 23 March 2020, and the period of pandemic from 24 March 2020 - 24 March 2021. Adherence to 19 predefined QI was evaluated for each patient’s treatment course. Multivariable analysis of adherence to QI was performed using proportional odds regression. Results154 patients underwent treatment, of whom 83 (53.9%) received treatment during the pandemic. 17 patients had COVID-19 infection before or during treatment. Adherence to QI decreased during the pandemic, primarily driven by delays in the start and delivery of treatment. The median number of QI adhered to in the pre pandemic period was 17 (IQR: 16 - 17.5) versus 17 during the pandemic (IQR: 16 - 17). Multivariable analysis showed that treatment during the pandemic period was associated with a lower adherence to QI (Odds ratio 3.30, 95% confidence intervals 1.70 - 6.50). ConclusionsThe COVID-19 pandemic was associated with reduced adherence to QI. Treatment delivery was affected not only by COVID-19 infection, but also logistic challenges due to restrictions related to the pandemic.