QUALITY ASSURANCE OF INTERSTITIAL BRACHYTHERAPY TECHNIQUE IN LIP CANCER - COMPARISON OF ACTUAL PERFORMANCE WITH THE PARIS SYSTEM RECOMMENDATIONS

This study takes a quality assurance approach to assessing staff appli cation of Paris System recommendations for brachytherapy. Between 1988 and 1992, 72 patients were treated with brachytherapy for cancer of t he lip at Hospital Clinic in Barcelona. Because of the relatively high number of total local recurrences (11%) and the fact that several rad iotherapists had come from other hospitals to join the staff, we analy sed the technique actually used compared with the recommendations of t he Paris System. Results indicate our staff did not, in fact, use the active length prescribed by the Paris System in 71% of cases but that the discrepancies had no observable impact on the actuarial local cont rol in the short follow-up period (28 +/- 15 months). When we compared , in time sequence, the first 35 patients treated between 1988 and 198 9 (Early group) with the last 37 treated between 1990 and 1992 (Later group), we saw that staff members had improved their application of th e therapy by more often using the recommended length of active lines. Staff performance in the Later group was still far from ideal, however , as the actual length used differed from the length recommended in 51 % of the cases. At present we are insisting on stricter application of the Paris System guidelines for lip brachytherapy. Our study suggests that auditing performance is worthwhile and we recommend that radioth erapists apply this analytical quality assurance method, especially wh en several new physicians join a department.