The outcome of radiotherapy (RT) is largely dose-dependant. The limiting factor in the therapeutic window is the dose delivered to the surrounding healthy tissues and organs at risk. Inaccurate dose delivery may result in serious side effects showing up as late as 15 years after the treatment. Under-dosage boosts the risk for tumour recurrence. For this reason the outcome of RT (therapeutic ratio) cannot be based on the cure rate alone but needs to take the long term disease free survival of the patient into account. Strict quality assurance procedures, including the monitoring of side effects need to be implemented as a precautionary measure. This will become even more mandatory with the introduction of conformal (CT) and intensity modulated therapy (IMRT) that makes dose escalation and hence the enhancement of the cancer cure rate possible. The aim of this project is to increase the confidence level of clinicians for embracing optimised RT treatment regimes by making sure they can be achieved without an increase in severe side effects. Actions proposed for this purpose: monitoring the accuracy of the dose (Task 1:EQUAL) and the side effects (Task 2: REACT), by stepping up education for the implementation of new technology (Task 3: EDRO) by developing quality assurance procedures for optimised RT (Task 4: QUASIMODO) and brachytherapy (interstitial and intracavitary treatment) (Task 6: BRAPHYQS), and establishing a procedure-based surveillance of quality in treatment and research ( Task 5:EPOQART).
Objectives
Task 1: EQUAL
This task will try to include in its external mailed TLD dosimetric audit up to 80 % of all the RT departments in Europe, while developing a methodology for checking also more complex asymmetric and MLC (multileaf collimated) fields.
Task 2: REACT (Register, Educate and Ameliorate the Consequences of Treatment)
This task intends to involve the patients in the assessment of consequences of treatment by developing a patient questionnaire. A consensus will be sought on levels of complexity for recording them, and an education programme for their recognition and recording will be put in place. Finally methods will be developed for the management of side effects . Click here for more details and reports
Task 3: EDRO (Education for Radiotherapy)
This task will focus on creating a European space for training and mobility in RT by the development/reviewing and promotion of European curricula for the education and practical training of all the disciplines involved in RT, by producing an easy-to-audit monitoring instrument for their professional training and development including Continuing Medical Education (CME): [the European Training Manual/ Record (TMR)], by stimulating the production and reproduction/publishing of cutting edge teaching material, by encouraging participation of trainees in state-of-the-art educational activities, by facilitating the transfer of technology and know how and by creating a broadened recruitment basis for research through research training fellowships.
Task 4: EPOQART (European Permanent Office for Quality Assurance in RT)
This task will serve as a co-ordinating structure for all the QA initiatives in the field of RT and develop a platform for the auditing and surveillance of Quality in the total Treatment Process and in Research in RT. This task was renamed EQART (European Institute for Quality Assurance in RT).
Task 5: QUASIMODO (Quality Assurance for Intensity Modulated Radiation Oncology)
This task will promote the safe introduction of advanced technology in RT by developing procedures for the QA of Treatment Planning Systems (TPS) to be published as a new issue in a series of ESTRO Physics Booklets, and by exploring a new methodology for the verification of Intensity Modulated Radiotherapy.
Task 6: BRAPHYQS
Thsi task will investigate methods for improving QA in Brachytherapy (the use of radioactive implants as opposed to external beam radiotherapy). QA procedures in different countries in Europe will be analysed and European guidelines issued to be published as a new issue in a series of ESTRO Physics booklets. A method for a mailed QC system will be developed for checking both dosimetric and geometric accuracy in brachytherapy departments.
Rationale
The ESQUIRE project will give a substantial boost to ESTRO?s sustained effort for setting a benchmark for quality in the practice of radiotherapy in Europe. By developing the human potential through education and optimising the use of capital intensive infrastructure, the outcome of radiotherapy treatment can be substantially improved. According to a in 2000 published EORTC study (Eur J Cancer 2000 Mar; 36 (5): 615-20, every gain in increasing the accuracy of beam output and treatment delivery will be directly translated into an important gain in uncomplicated cure probability and result in saving the lives of thousands of cancer patients every year. 50% of Europe?s cancer patients are treated with RT. It has been estimated by the Swedish Council of Technology Assessment that theoretically it would be possible to increase the 5-year survival of these patients by more than 10% during a 10 year period if the radiation treatment quality is improved.
Project ID
Acronym: ESQUIRE
EU Programme: Europe Against Cancer Programme
Project Principal Co-ordinator: ESTRO#
Project Leader: Pr. Hans Svensson
European Commission: Public Health Directorate
ESQUIRE Year 1
- EU Contract Number: S12.322029
- Starting Date: this project has started on 1 August 2001
- Duration: 24 months from starting date
- Total estimated budget: EUR 3 282 676,00
- EU funding received: EUR 2 070 000,00.
- Current status: The project has ended.
- The final report has been published by the European Commission.
ESQUIRE Year 2
- EU Contract Number: SPC.2002480
- Starting Date: 1 October 2002
- Duration of the Project: 12 months + 2 months
- Total estimated budget: EUR 2 476 127,00
- EU funding received: EUR 1 500 000,00
- Current Status: The project has ended
Who Contributed to ESQUIRE?
The extensive list of partners involved in the project shows how crucial a collaboration was needed to perform the 6 tasks it aimed at. ESTRO wishes to deeply thank all the participants who contrributed during two years and without whom the achievements would not have been so successful.
The Task Leaders
EQUAL: Andrée Dutreix
REACT: Ann Barrett
EDRO: Michael Baumann
EPOQART: Eric Lartigau-Dominique Huyskens
QUASIMODO: Ben Mijnheer
BRAPHYQS: Jack Venselaar
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