title: Quality Research in Radiation Oncology analysis of clinical performance measures in the management of gastric cancer.
abstract: BACKGROUND
  The specific aim was to determine national patterns of radiation therapy (RT) practice in patients treated for stage IB-IV (nonmetastatic) gastric cancer (GC).
  
  
  METHODS
  A national process survey of randomly selected US RT facilities was conducted which retrospectively assessed demographics, staging, geographic region, practice setting, and treatment by using on-site record review of eligible GC cases treated from 2005 to 2007. Three clinical performance measures (CPMs), (1) use of computed tomography (CT)-based treatment planning; (2) use of dose volume histograms (DVHs) to evaluate RT dose to the kidneys and liver; and (3) completion of RT within the prescribed time frame; and emerging quality indicators, (i) use of intensity modulated RT (IMRT); (ii) use of image-guided tools (IGRT) other than CT for RT target delineation; and (iii) use of preoperative RT, were assessed.
  
  
  RESULTS
  CPMs were computed for 250 eligible patients at 45 institutions (median age, 62 years; 66% male; 60% Caucasian). Using 2000 American Joint Committee on Cancer criteria, 13% of patients were stage I, 29% were stage II, 32% were stage IIIA, 10% were stage IIIB, and 12% were stage IV. Most patients (43%) were treated at academic centers, 32% were treated at large nonacademic centers, and 25% were treated at small to medium sized facilities. Almost all patients (99.5%) underwent CT-based planning, and 75% had DVHs to evaluate normal tissue doses to the kidneys and liver. Seventy percent of patients completed RT within the prescribed time frame. IMRT and IGRT were used in 22% and 17% of patients, respectively. IGRT techniques included positron emission tomography (n=20), magnetic resonance imaging (n=1), respiratory gating and 4-dimensional CT (n=22), and on-board imaging (n=10). Nineteen percent of patients received preoperative RT.
  
  
  CONCLUSIONS
  This analysis of radiation practice patterns for treating nonmetastatic GC indicates widespread adoption of CT-based planning with use of DVH to evaluate normal tissue doses. Most patients completed adjuvant RT in the prescribed time frame. IMRT and IGRT were not routinely incorporated into clinical practice during the 2005-2007 period. These data will be a benchmark for future Quality Research in Radiation Oncology GC surveys.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA. goodmank@mskcc.org
authors.forename: Karyn A
authors.initials: KA
authors.lastname: Goodman
authors.forename: Najma
authors.initials: N
authors.lastname: Khalid
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Kachnic
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Minsky
authors.forename: Cheryl
authors.initials: C
authors.lastname: Crozier
authors.forename: Jean B
authors.initials: JB
authors.lastname: Owen
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Devlin
authors.forename: Charles R
authors.initials: CR
authors.lastname: Thomas
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities / Q000592:standards; D005260:Female; D056973:Four-Dimensional Computed Tomography / Q000706:statistics & numerical data; D019983:Guideline Adherence; D006801:Humans; D007668:Kidney / Q000528:radiation effects; D008099:Liver / Q000528:radiation effects; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D058958:Organs at Risk / Q000528:radiation effects; D049268:Positron-Emission Tomography / Q000706:statistics & numerical data; D011300:Preoperative Care; D019984:Quality Indicators, Health Care; D018787:Radiation Oncology / Q000379:methods / Q000592:standards*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods / Q000592:standards*; D061089:Radiotherapy, Image-Guided / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000706:statistics & numerical data; D055425:Respiratory-Gated Imaging Techniques / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012494:Sampling Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D013997:Time Factors; D014481:United States