Can Radiation Therapy Quality Assurance Improve Nasopharyngeal Cancer Outcomes in Low and Middle-Income Countries—Reporting the Technical Component of the Second Phase of a Prospective International Atomic Energy Agency study (E33039)

Abstract

Purpose: Most of new nasopharyngeal cancer (NPC) cases occur in low- and middle-income countries (LMICs), but these patients experience poorer survival than new NPC cases in high income countries. This study seeks to determine whether a radiation therapy quality assurance (RT QA) program can improve patients with NPC outcomes in LMICs. Here we report the technical results of the second phase of the International E33039 study. Methods and Materials: Phase 1 of this study included an audit by an expert panel of 134 NPC patients’ RT plans from LMICs. It was previously reported and showed a 64% rate of unacceptable plans. Detailed RT QA reports was given to each center, followed by an educational face-to-face workshop discussing the results and improvement plans. Thereafter accrual for phase 2 commenced. The primary endpoint of the technical component of phase 2 is the number of major deviations in priority 1 parameters as compared with phase 1. Results: A total of 153 patients accrued from 9 centers between April 2020 and April 2023 in phase 2. Notably, 105 (68.6%) were reviewed pretreatment as per protocol, and 48 (31.4%) were reviewed after treatment (not per protocol, because of technical reasons). Of the plans reviewed pretreatment, 31 of 105 (29.5%) were unacceptable because of major deviations in priority one structures. Thirty cases (30/31, 96.8%) were resubmitted and 20 were deemed acceptable (an improvement of 20/30, 66.7%). Of the plans reviewed posttreatment, 6/48 (12.5%) were unacceptable. The overall rate of unacceptable plan was 11% (17/153) in phase 2 compared with 64% in phase 1. Conclusions: This prospective study shows that RT QA and education for NPC RT plans in LMICs can dramatically reduce major RT protocol deviations. This will hopefully translate into improved patient outcomes.