title: Quality assurance in radiotherapy: analysis of the causes of not starting or early radiotherapy withdrawal.
abstract: BACKGROUND
  The aim of this study was to analyse the reasons for not starting or for early of radiotherapy at the Radiation Oncology Department.
  
  
  METHODS
  All radiotherapy treatments from March 2010 to February 2012 were included. Early withdrawals from treatment those that never started recorded. Clinical, demographic and dosimetric variables were also noted.
  
  
  RESULTS
  From a total of 3250 patients treated and reviewed, 121 (4%) did not start or complete the planned treatment. Of those, 63 (52%) did not receive any radiotherapy fraction and 58 (48%) did not complete the course, 74% were male and 26% were female. The mean age was 67 ± 13 years. The most common primary tumour was lung (28%), followed by rectum (16%). The aim of treatment was 62% radical and 38% palliative, 44% of patients had metastases; the most common metastatic site was bone, followed by brain. In 38% of cases (46 patients) radiotherapy was administered concomitantly with chemotherapy (10 cases (22%) were rectal cancers). The most common reason for not beginning or for early withdrawal of treatment was clinical progression (58/121, 48%). Of those, 43% died (52/121), 35 of them because of the progression of the disease and 17 from other causes. Incomplete treatment regimens were due to toxicity (12/121 (10%), of which 10 patients underwent concomitant chemotherapy for rectal cancer).
  
  
  CONCLUSIONS
  The number of patients who did not complete their course of treatment is low, which shows good judgement in indications and patient selection. The most common reason for incomplete treatments was clinical progression. Rectal cancer treated with concomitant chemotherapy was the most frequent reason of the interruption of radiotherapy for toxicity.
authors.affiliation: Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d'Investigacions Sanitàries Pere Virgili (IISPV), Universitat Rovira i Virgili (URV), Tarragona, Spain. meritxell.arenas@gmail.com.
authors.forename: Meritxell
authors.initials: M
authors.lastname: Arenas
authors.affiliation: Department of Radiation Oncology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain. ssabaterm@gmail.com.
authors.forename: Sebastià
authors.initials: S
authors.lastname: Sabater
authors.affiliation: Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d'Investigacions Sanitàries Pere Virgili (IISPV), Universitat Rovira i Virgili (URV), Tarragona, Spain. mgasconf@gmail.com.
authors.forename: Marina
authors.initials: M
authors.lastname: Gascón
authors.affiliation: Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d'Investigacions Sanitàries Pere Virgili (IISPV), Universitat Rovira i Virgili (URV), Tarragona, Spain. ohenriquez@grupsagessa.com.
authors.forename: Ivan
authors.initials: I
authors.lastname: Henríquez
authors.affiliation: Department of Quality, Hospital Universitari Sant Joan de Reus, Tarragona, Spain. mjbueno@grupsagessa.com.
authors.forename: M José
authors.initials: MJ
authors.lastname: Bueno
authors.affiliation: Department of Statistics, Hospital Universitari Sant Joan de Reus, Tarragona, Spain. arius@grupsagessa.com.
authors.forename: Àngels
authors.initials: À
authors.lastname: Rius
authors.affiliation: Department of Radiation Oncology, Hospital Universitari Clínic de Barcelona, Barcelona, Spain. rovirosa@clinic.ub.es.
authors.forename: Àngels
authors.initials: À
authors.lastname: Rovirosa
authors.affiliation: Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d'Investigacions Sanitàries Pere Virgili (IISPV), Universitat Rovira i Virgili (URV), Tarragona, Spain. dgomez@grupsagessa.com.
authors.forename: David
authors.initials: D
authors.lastname: Gómez
authors.affiliation: Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d'Investigacions Sanitàries Pere Virgili (IISPV), Universitat Rovira i Virgili (URV), Tarragona, Spain. alafuerza@grupsagessa.com.
authors.forename: Anna
authors.initials: A
authors.lastname: Lafuerza
authors.affiliation: Department of Radiation Oncology, Hospital Universitari Clínic de Barcelona, Barcelona, Spain. abiete@clinic.ub.es.
authors.forename: Albert
authors.initials: A
authors.lastname: Biete
authors.affiliation: Hospital Universitari Sant Joan de Reus and Group SAGESSA (Assistència Sanitària i Social), Tarragona, Spain. jcolomer@grupsagessa.com.
authors.forename: Jordi
authors.initials: J
authors.lastname: Colomer
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000532:radiotherapy*; D011785:Quality Assurance, Health Care; D011878:Radiotherapy; D016312:Treatment Refusal / Q000706:statistics & numerical data*