title: Preoperative radiotherapy for rectal cancer: a comparative study of quality control adherence at two cancer hospitals in Spain and Poland.
abstract: BACKGROUND
  We performed a clinical audit of preoperative rectal cancer treatment at two European radiotherapy centres (Poland and Spain). The aim was to independently verify adherence to a selection of indicators of treatment quality and to identify any notable inter-institutional differences.
  
  
  METHODS
  A total of 162 patients, in Catalan Institute of Oncology (ICO) 68 and in Greater Poland Cancer Centre (GPCC) 94, diagnosed with locally advanced rectal cancer and treated with preoperative radiotherapy or radio-chemotherapy were included in retrospective study. A total of 7 quality control measures were evaluated: waiting time, multidisciplinary treatment approach, portal verification, in vivo dosimetry, informed consent, guidelines for diagnostics and therapy, and patient monitoring during treatment.
  
  
  RESULTS
  Several differences were observed. Waiting time from pathomorphological diagnosis to initial consultation was 31 (ICO) vs. 8 (GPCC) days. Waiting time from the first visit to the beginning of the treatment was twice as long at the ICO. At the ICO, 82% of patient experienced treatment interruptions. The protocol for portal verification was the same at both institutions. In vivo dosimetry is not used for this treatment localization at the ICO. The ICO utilizes locally-developed guidelines for diagnostics and therapy, while the GPCC is currently developing its own guidelines.
  
  
  CONCLUSIONS
  An independent external clinical audit is an excellent approach to identifying and resolving deficiencies in quality control procedures. We identified several procedures amenable to improvement. Both institutions have since implemented changes to improve quality standards. We believe that all radiotherapy centres should perform a comprehensive clinical audit to identify and rectify deficiencies.
authors.affiliation: Department of Radiotherapy, Greater Poland Cancer Centre, Poznan, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Fundowicz
authors.affiliation: Department of Radiotherapy, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Macia
authors.affiliation: Department of Radiotherapy, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain.
authors.forename: Susanna
authors.initials: S
authors.lastname: Marin
authors.affiliation: Department of Training, Scientific Cooperation and Quality Assurance, Greater Poland Cancer Centre, Poznan, Poland.
authors.forename: Marta
authors.initials: M
authors.lastname: Bogusz-Czerniewicz
authors.affiliation: Department of Medical Physics, Greater Poland Cancer Centre, Poznan, Poland.
authors.forename: Ewelina
authors.initials: E
authors.lastname: Konstanty
authors.affiliation: Department of Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain.
authors.forename: Ignaci
authors.initials: I
authors.lastname: Modolel
authors.affiliation: Department of Medical Physics, Greater Poland Cancer Centre, Poznan, Poland ; Department osf Electroradiology, University of Medical Sciences, Poznan, Poland.
authors.forename: Julian
authors.initials: J
authors.lastname: Malicki
authors.affiliation: Department of Radiotherapy, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Guedea
keywords: clinical audit; preoperative radiotherapy; quality control