The Royal College of Radiologists National Vulvar Cancer Audit

P Baird; K Drinkwater; J Forrest; A J Stewart

doi:10.1016/j.clon.2024.03.024

The Royal College of Radiologists National Vulvar Cancer Audit

Clin Oncol (R Coll Radiol). 2024 Mar 29:S0936-6555(24)00138-9. doi: 10.1016/j.clon.2024.03.024. Online ahead of print.

Authors

P Baird¹, K Drinkwater², J Forrest³, A J Stewart⁴

Affiliations

¹ Belfast Health and Social Care Trust, Belfast, UK.
² Royal College of Radiologists, London, UK.
³ Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
⁴ St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK; University of Surrey, Guildford, UK. Electronic address: alexandra.stewart@nhs.net.

PMID: 38658266
DOI: 10.1016/j.clon.2024.03.024

Abstract

Aims: This audit examined UK vulvar cancer practice from March 2018 to January 2019 and compared it to standards from national and international recommendations. Follow-up data collection in 2020 examined patient outcomes and toxicity.

Materials and methods: Audit standards were based on Royal College of Radiologists (RCR) guidance and published literature. A web-based questionnaire was sent to the audit leads at all cancer centres in the UK. Prospective data collection included patient demographics, tumour characteristics, radiotherapy indications, dosimetry, timelines, and follow-up data. The audit targets were 95% compliance with the RCR dose/fractionation schemes in definitive and adjuvant patients, 40% use of intensity modulated radiotherapy (IMRT), 100% of radical patients treated as category 1, and 95% use of gap compensation for category 1 patients.

Results: 34/54 UK radiotherapy centres (63%) completed data entry for 152 patients. 23 out of 34 (68%) centres submitted follow-up data for 94 patients. One indicator exceeded the audit target: 98% of radical patients received IMRT. The indicators of RCR dose/fractionation compliance for adjuvant/definitive radiotherapy were achieved by 80%/43% for the primary, 80%/86% for elective lymph nodes, and 21%/21% for pathological lymph nodes. The use of concomitant chemotherapy with radical radiotherapy in suitable patients was achieved by 71%. Other indicators demonstrated that 78% were treated as category 1 and 27% used gap compensation. Acute toxicity was mostly related to skin, gastrointestinal, and genitourinary sites. Grade 3 and Grade 4 toxicities were seen at acceptable rates within the radical and adjuvant groups. Late toxicity was mostly grade 0.

Conclusion: This audit provides a comprehensive picture of UK practice. IMRT is widely used in the UK, and treatment-related toxicity is moderate. The dose fractionation was very heterogeneous. The designation of vulvar cancer as category 1 was not regularly followed for radical/adjuvant patients, and there was minimal gap compensation during treatment.

Keywords: IMRT; Royal College of Radiologists; national audit; vulvar cancer.