Referral to radiation oncology prior to prostatectomy: Referral rates in a New Zealand tertiary Centre.

BACKGROUND: Radical prostatectomy and radical radiotherapy have equivalent survival outcomes in the treatment of localised prostate cancer but differing side-effect profiles. The 2018 Faculty of Radiation Oncology of the Royal Australasian College of Radiologists (RANZCR) position statement recommends that patients have the opportunity to discuss all suitable treatment options, ideally with the relevant specialist. This study aimed to determine the number and characteristics of men referred to radiation oncology before undergoing radical prostatectomy in the years immediately preceding the 2018 RANZCR position statement. METHODS: The electronic records of all men who underwent a radical prostatectomy in the Auckland region between 1 January 2016 and 31 December 2017 were retrospectively reviewed for documentation of a referral or offer of referral to radiation oncology, or multidisciplinary meeting (MDM) consensus for surgery before prostatectomy. Patient and tumour variables were collected. RESULTS: Between 1 January 2016 and 31 December 2017, 234 patients underwent radical prostatectomy for prostate cancer in the wider Auckland region. Before undergoing prostatectomy, 89 of 234 patients (38.0%) were referred, offered but declined referral, or had MDM consensus for surgery. Age and urologist were most strongly correlated with the primary outcome; those offered referral were older than those who were not (P = 0.030). The practice of one urologist was an outlier, referring or recommending referral to 92.3% of patients (P < 0.0001). CONCLUSION: These results provide a benchmark for future studies assessing referral practices following the RANZCR position statement, and suggest a need for further education and advocacy regarding the role of radiotherapy in the treatment of localised prostate cancer.

Survey of brachytherapy training experience among radiation oncology trainees and fellows in the Royal Australian and New Zealand College of Radiologists (RANZCR).

INTRODUCTION: To evaluate brachytherapy training experience among trainees and fellows trained through the Royal Australian and New Zealand College of Radiologists (RANZCR). METHODS: All current trainees and fellows (who obtained fellowship from 2015 onwards) were sent an online anonymous questionnaire on various aspects of brachytherapy training, including number of cases observed/ performed, opinions on brachytherapy assessment during training, barriers to brachytherapy training and future role of brachytherapy. RESULTS: The overall survey response rate was 24% (40/161 trainees, 30/126 fellows). Of the 70 respondents, 50 (71%), 38 (54%) and 43 (61%) reported to have received formal brachytherapy teaching from radiation oncologists, radiation therapists and medical physicists respectively. Most respondents had exposure to gynaecology brachytherapy - two-thirds of trainees and all fellows have performed at least one gynaecology brachytherapy procedure. Prostate brachytherapy exposure was more limited - by the end of training, 27% and 13% of fellows did not have exposure to LDR and HDR prostate brachytherapy. More than two-thirds indicated there should be a minimum number of brachytherapy case requirements during training, and half indicated that trainees should be involved in ≥6 gynaecology brachytherapy procedures. Barriers affecting training include lack of caseload (70%) and perceived decreasing role of brachytherapy (66%). Forty-three percent of respondents were concerned about the decline in brachytherapy utilisation. CONCLUSION: This is the first survey on brachytherapy training experience among RANZCR trainees and fellows. It highlighted limited brachytherapy exposure during RANZCR training, and the need to revisit brachytherapy training requirement in the current training programme, along with long-term brachytherapy workforce planning.

30-day mortality following palliative radiotherapy.

INTRODUCTION: Patients dying a short time after receiving palliative radiation are unlikely to have received benefit and may experience harm. To monitor the potential for avoidable harm, 30-day mortality following palliative radiation has been recommended for use as a quality indicator and the Royal College of Radiologist have recommended a rate of lower than 20%. At the Canterbury Regional Cancer and Haematology Service in Christchurch, New Zealand (CRCHS), we investigated 30-day mortality and evaluated the prognostic value of the TEACHH model in our population. METHODS: Palliative treatments from two, two-year periods (2012/2013 and 2016/2017) were retrospectively reviewed. We analysed 30-day mortality and several influencing variables. Patients were divided into three groups using the TEACHH model (type of cancer, performance status, age, prior palliative chemotherapy, prior hospitalizations and hepatic metastases). RESULTS: There were 1744 patients; 30-day mortality was 10% and was higher in patients with lung cancer (17% vs. 8% in non-lung cancer patients, P < 0.0001), patients having less than five fractions (13% vs. 9%, P: 0.0199) and patients in TEACHH group B/C (21% in C, 11% in B and 2% in group A, P < 0.0001). The majority of treatments (84%) used five fractions or less. CONCLUSIONS: The mortality rate is within the suggested quality indicator, and the decreasing mortality with increasing fractionation demonstrates suitable selection of patients for longer treatment regimens. The TEACHH model can be used to increase precision in estimating prognosis, identifying patients who should not receive treatment and conversely identifying those for whom a prolonged fractionation schedule may be appropriate.