Radiotherapy site specific improvement metrics for England

Publication date: 12 June 2025

Version	Date	Time period	Update reason
v1.0	08 May 2025	1 January 2020 to 30 June 2024
v1.1	12 June 2025	1 January 2020 to 30 June 2024	Correction of redacted email address, addition of data quality statements, corrections to Lung 7a and Oesophago-gastric 1a.

Introduction

The aim of the radiotherapy site specific improvement metrics is to support radiotherapy providers, Operational Delivery Networks (ODNs) and Integrated Care Boards (ICBs) to identify possible variation, improve treatment standardisation, deliver evidence-based best practice and rollout new evidence-based treatments. Additionally, these metrics aim to support the implementation of Royal College of Radiologists (RCR) consensus statements and National Institute for Health and Care Excellence (NICE) guidance in England for radiotherapy planning and treatment.

The development of the metrics was undertaken by 7 site specific working groups with representation from clinicians and NDRS Radiotherapy Dataset (RTDS) team members. The process involved reviewing NICE guidelines and RCR consensus statements by tumour type and identifying rationale and evidence for each potential metric before proposing a numerator and denominator. Next, data sources were identified (predominantly the RTDS) and initial results were presented back to the clinical working group for review to ensure accuracy and quality, and to confirm the metrics were fit for purpose. The final agreement of the metrics was therefore decided based on utility for clinical teams by the working groups.

The metrics cover 7 tumour sites: breast, prostate, rectal, head and neck, oesophago-gastric, lung and anal cancers. This report includes a highlight metric for each tumour site for the period 01 January 2020 to 30 June 2024. Metrics are presented at a national level with variation between providers and over time shown. Provider level data for these 7 highlight metrics and the full 37 radiotherapy improvement metrics is available on the CancerStats2 secure platform.

Methods

Metric methodology

The metrics contained in this report are listed below, full definitions are included for each metric in the Results section.

Breast metric 1a: Percentage of episodes for malignant breast cancers receiving 5 fraction radiotherapy.
Prostate metric 4: Percentage of radical prostate radiotherapy delivered using moderate hypofractionation
Rectal metric 2a: Percentage of episodes of radical intent radiotherapy for rectal cancer which use a short course regimen
Lung metric 7a: Percentage of Performance Status (PS) 0-1 stage 3 Non Small Cell Lung Cancer (NSCLC) treated with radical concurrent chemo-radiotherapy (Chemo-RT)
Head and neck metric 5a: Percentage of adjuvant radiotherapy treatments of head and neck mucosal cancers that start within 6 weeks of surgery
Oesophago-gastric metric 1a: Percentage of episodes of radical intent radiotherapy for oesophago-gastric cancer which utilise Intensity Modulated Radiotherapy (IMRT)
Anal metric 3a: Percentage of episodes where treatment was completed in the expected time

RTDS activity is defined as a unique count of treatment episodes. A treatment episode is defined as a continuous period of care for radiotherapy including all preparation, planning and delivery of radiotherapy. Episodes are reported in the month they started in.

Data sources

The metrics presented in this report are calculated in the most part from the data submitted to the Radiotherapy Dataset (RTDS). RTDS activity is defined as a count of unique treatment episodes. A treatment episode is defined as a continuous period of care for radiotherapy including all preparation, planning and delivery of radiotherapy. Episodes are reported in the month they started in.

In addition to RTDS data, the following metrics utilise data from the Rapid Cancer Registration Dataset (RCRD) to support identification of the denominator population:

Head and Neck metric 5a: Percentage of adjuvant radiotherapy treatments for head and neck mucosal cancers that start within 6 weeks of surgery

The following metric also utilises data from the National Cancer Registration Data (NCRD) dataset to support identification of concurrent chemotherapy delivery for NSCLCs:

Lung metric 7a: Percentage of PS 0-1 stage 3 NSCLC treated with radical concurrent chemo-radiotherapy (Chemo-RT)

More information about RTDS, RCRD and is available at the below links:

The following metric utilises a resection lookup based on OPCS4 codes captured in the inpatient Hospital Episode Statistics datasets. This list was developed for the Cancer treatments - NDRS publication and supports identification of major resections for head and neck cancer:

Head and neck metric 5a: Percentage of adjuvant radiotherapy treatments of head and neck mucosal cancers that start within 6 weeks of surgery

The lookup is available here: Cancer-Treatments/opcs4resection_lookup.csv at main · NHSE-NDRS/Cancer-Treatments · GitHub

Inclusion criteria

Patients treated with radiotherapy in England from 1 January 2020 until 30 June 2024 from all age groups are included. Data is aggregated by provider (and summarised at national level) and six-month period (Jan-Jun and Jul-Dec).

The tumour sites are defined by ICD10 codes as follows:

Tumour site	ICD10 code(s)
Anal	C21
Breast	C50
Head and Neck*	C00-C14, C30-C32
Lung**	C33, C34
Oesophago-gastric***	C15, C16
Prostate	C61
Rectal	C18-C20

Full details of NDRS detailed cancer group definitions is available here: Standard cancer group definitions

*Head and neck in this report differs from the standard groupings slightly as it includes ICD10 codes for external lip (C00.0, C00.1 and C00.2). In radiotherapy, doses and toxicity are similar for external lip as for the rest of the head and neck cancer group so it was deemed a better categorisation than the skin cancer grouping.

**NCRD detailed tumour site = Non-small cell lung cancer (morphology code not in 8002, 8041, 8042, 8043, 8044, 8045).

***In the NDRS standard cancer group definitions oesophagus and stomach cancers are in separate groups, in this report oesophago-gastric is a single group, this aligns with the gastro-oesophageal group in RCR guidelines.

All providers in England who deliver radiotherapy are included, with the exception of Moorfields Eye Hospital (RP6) as they only deliver radiotherapy using unsealed radionuclide sources. This includes all patient activity associated with the provider, regardless of patient postcode (including overseas, null, invalid etc.).

Patients have been excluded from the metrics Breast 1a and Prostate 4 where a sex-specific diagnosis code does not match the person-stated gender. This may have excluded some transgender and non-binary patients. The NDRS Inequalities in cancer webpage provides more details.

Data quality and caveats

Providers

Calculation of the lowest, highest and median provider percentages reported in the summary tables are based on providers with 5 or more episodes in the data period, providers with less than 5 episodes meeting the denominator definition are excluded.

The Royal Marsden NHS Foundation Trust (RPY) have RTDS data missing between April 2023 and December 2023. This will impact on their reported metric figures as well as the national figures in the periods January 2023 to June 2023 and July 2023 to December 2023, with only partial data for them in the former and missing in the latter. The Royal Marsden typically account for 3-4% of all radiotherapy episodes in England.

Data submitted by the Northern Care Alliance NHS Foundation Trust (RM3) is grouped with and reported under The Christie NHS Foundation Trust (RBV).

North Cumbria Integrated Care NHS Foundation Trust (RNN) merged with The Newcastle Upon Tyne NHS Foundation Trust (RTD) from April 2023. Data reported for RNN in the period January 2023 to June 2023 will therefore not represent a full six-month period, with all data reported under RTD from this point onwards.

Radiotherapy intent

From October 2023, Cambridge University Hospitals NHS Foundation Trust (RGT) submitted all palliative episodes as radical, this was due to errors in the Trust’s mapping process. The impact of this issue is small overall, with the incorrectly mapped palliative activity constituting approximately 100 episodes per month which makes up around 3% of England’s total monthly palliative activity, though this is 35% of the Trust’s monthly activity. The Trust is aware of the issue, and both the submission mappings and the RTDS data held by NDRS are being corrected.

The Christie NHS Foundation Trust (RBV) have incorrectly coded some episodes as Other intent rather than Radical or Palliative. This affects their activity from 2023 onwards and is most pronounced in May to August 2024 when 47% of their episodes are coded as Other. The Christie typically account for approximately 6.5% of all radiotherapy episodes in England.

The RTDS data liaison team are aware of these issues and working to correct them in the near future.

Rapid Cancer Registration Data

Data from the RCRD is based on a rapid processing of cancer registration data sources, in particular the Cancer Outcomes and Services Dataset (COSD) information and only includes diagnoses since 2018. In comparison, National Cancer Registration Data (NCRD) relies on additional data sources, enhanced follow-up with trusts and expert processing by cancer registration officers and includes diagnoses since 1995.

Therefore, metrics based on RCRD data should only be treated as indicative of the total numbers and trends, as RCRD data is not complete and it is subject to change, for example as more data becomes available. See the latest RCRD data quality document for more details on the limitations in the data quality and completeness of RCRD data.

Comparison of the diagnoses recorded in RCRD and in NCRD has shown that:

Across all cancer types included in RCRD, approximately 11.5% of cases are missing and 6.0% of cases are included erroneously or with incorrect cancer type or diagnosis date (when compared to ‘Gold Standard’ registration data for 2018 data).

Based on the benefits of having more recent data for reporting and that the rates of data completeness and quality for RCRD make it a representative dataset, it was felt to be the best data source for surgical tumour resection activity for these metrics. Additionally, the metrics focus on cancers which are relatively common, and these perform best in terms of RCRD data quality.

Adjuvant episodes

Following consultation with the clinical groups, the definition of adjuvant episodes for use in these metrics was agreed to be those which have a start date of radiotherapy within 3 months of the last surgical date. The intention was to exclude treatments which could be for early recurrence. This means that the number of episodes with a start date of radiotherapy occurring just within or just outside of this 3 month cut-off can have an impact on percentages for metrics only considering adjuvant episodes, namely head and neck 5a. Approximately 95% of radiotherapy episodes for head and neck which follow surgery fall within the 3 month window.

Case mix

These clinical metrics do not take into account the case mix of the patients included, for example there is no standardisation for age or gender and other factors which may impact upon clinical decision making.

Patients treated in more than one trust or with more than one tumour may have episodes counted twice by provider or tumour site.

Acronyms

Chemo-RT: Chemo-radiotherapy

COSD: Cancer Outcomes and Services Dataset

ICB: Integrated Care Board

IMRT: Intensity Modulated Radiotherapy

NDRS: National Disease Registration Service

NICE: National Institute for Health and Care Excellence

NSCLC: Non Small Cell Lung Cancer

ODN: Operational Delivery Network

OPCS4: OPCS Classification of Interventions and Procedures Version 4

NCRD: National Cancer Registration Data

PS: Performance Status

PTV: Planning Target Volume

RCR: Royal College of Radiologists

RCRD: Rapid Cancer Registration Data

RTDS: Radiotherapy Data Set

Key findings

Breast metric 1a

The percentage of episodes delivered for invasive breast cancers using a 5 fraction regimen increased from 35% in Jan-Jun 2020 to 69% in Jul-Dec 2020 and to 82% in Jan-Jun 2024.
From January 2023, the percentage of episodes for invasive breast cancers receiving 5 fraction radiotherapy was above 50% for all providers and above 84% for at least half of providers.
This metric suggests that the change in clinical practice which occurred during the Covid19 pandemic, in line with the results of the FAST-FORWARD trial has been sustained.

Prostate metric 4

The percentage of radical prostate radiotherapy which is moderately hypofractionated increased from 76% to 85% between January 2020 and June 2024.
From January 2021, the percentage of radical prostate radiotherapy which is moderately hypofractionated was above 80% for at least half of providers.

Rectal metric 2a

The percentage of radical intent episodes delivered for rectal cancer which use a short-course regimen is between 31% to 33% from January 2021 to December 2023, before a decrease to 28% in Jan-Jun 2024
There is substantial variation between providers. Since July 2020, half of providers have fallen in the range 10-45%.

Lung metric 7a

The percentage of PS 0-1 stage 3 NSCLCs treated with radical concurrent chemo-radiotherapy increased from 23% to 36% between January 2020 and June 2022 before a decrease to 33% in Jul-Dec 2022.

Head and neck metric 5a

The percentage of adjuvant radiotherapy episodes for head and neck mucosal cancers that start within 6 weeks of surgery decreased from 34% to 14% between July 2020 and June 2024, with substantial variation between providers. The median provider reached a high of 28% of episodes starting within 6 weeks of surgery in Jul-Dec 2020 with this level falling consistently below 20% since Jan-Jun 2022.
Between July 2020 and December 2021, the number of episodes receiving treatment within 3 months of surgery increased and the number of episodes receiving treatment within 6 weeks decreased leading to a decreasing trend in the percentage value for this metric. The gap between the number of episodes treated within 3 months and 6 weeks of surgery widened further between July 2023 and June 2024.

Oesophago-gastric metric 1a

The percentage of radical radiotherapy episodes for oesophago-gastric cancers planned using IMRT increased from 82% to 92% between January 2020 and June 2023 and decreased to 88% in Jan-Jun 2024. Despite this overall high-level of IMRT use, there were a few outlying providers in each six-month period, using IMRT for less than 62.5% of episodes.
From January 2021, the percentage of radical episodes of oesophago-gastric cancers planned using IMRT was 98% or above for at least half of providers with 5 or more episodes.

Anal metric 3a

The RCR recommendation of 95% was only achieved at a national level in the Jul-Dec 2022 period.

Results

Breast metric 1a

Percentage of episodes for malignant breast neoplasms receiving 5 fraction radiotherapy

Overall trend, England

Breast metric 1a: England percentage by 6 month period

Summary table

With 111,730 episodes entering into the analysis from the 1 January 2020 to 30 June 2024, the metric figures can be summarised below:

Data period	England overall (%)	Lowest provider (%)*	Highest provider (%)*	Median provider (%)*	Number of providers (5 or more episodes)
2020 JAN - JUN	35.4	10.2	58.9	38.1	49
2020 JUL - DEC	69.0	18.4	96.7	74.7	49
2021 JAN - JUN	75.2	28.2	98.2	79.1	49
2021 JUL - DEC	76.5	19.8	97.1	80.5	49
2022 JAN - JUN	77.6	16.1	98.5	81.8	49
2022 JUL - DEC	79.3	33.2	99.3	84.6	50
2023 JAN - JUN	80.4	54.8	100.0	84.5	50
2023 JUL - DEC	81.0	58.7	99.8	85.0	48
2024 JAN - JUN	81.9	53.7	100.0	85.4	49

*Lowest, highest and median provider percentages are based on providers with 5 or more episodes in the data period.

Results by provider volume

Breast metric 1a: Provider percentage by 6 month period

Metric methodology

Rationale: FAST-FORWARD showed that 26Gy in 5 fractions is non-inferior to 40Gy in 15 fractions. This has since been recommended in the RCR guidelines as the standard of care for patients requiring adjuvant radiotherapy for non-nodal breast or chest-wall without immediate reconstruction.

Data sources: RTDS

Denominator: All episodes of radical intent external beam radiotherapy for invasive breast cancer

Radiotherapy tumour site = breast, ICD10 = C50
First prescription treatment region = primary
Treatment modality = external beam
Patient gender = female

Numerator: All episodes in the denominator where the prescription with the earliest attendance was 25-27Gy in 5 fractions

Prostate metric 4

Percentage of radical prostate radiotherapy delivered using moderate hypofractionation

Overall trend, England

Prostate metric 4: England percentage by 6 month period

Summary table

With 61,166 episodes entering into the analysis from the 1 January 2020 to 30 June 2024, the metric figures can be summarised below:

Data period	England overall (%)	Lowest provider (%)*	Highest provider (%)*	Median provider (%)*	Number of providers (5 or more episodes)
2020 JAN - JUN	76.3	17.6	97.0	76.3	50
2020 JUL - DEC	79.8	39.2	96.9	79.9	50
2021 JAN - JUN	78.2	32.0	100.0	81.5	50
2021 JUL - DEC	78.4	26.8	98.2	80.9	50
2022 JAN - JUN	80.0	43.5	96.2	84.3	50
2022 JUL - DEC	82.9	40.9	98.2	84.0	50
2023 JAN - JUN	83.8	44.4	98.6	84.5	50
2023 JUL - DEC	83.6	39.3	97.0	87.5	48
2024 JAN - JUN	85.0	48.5	99.2	88.7	49

*Lowest, highest and median provider percentages are based on providers with 5 or more episodes in the data period.

Results by provider volume

Prostate metric 4: Provider percentage by 6 month period

Metric methodology

Rationale: The CHHiP trial showed that moderate hypofractionation is non-inferior in intermediate risk prostate cancer to conventional fractionation for men with localised prostate cancer. NICE guidance recommends the use of 60Gy in 20 fractions (19 fractions in the 75+ age category) for radical external beam radiotherapy for prostate cancer unless contra-indicated.

Data sources: RTDS

Denominator: Episodes for prostate cancer delivered with radical intent where the earliest prescription for non-stereotactic radiotherapy has treatment region code “primary”

Radiotherapy tumour site = prostate, ICD10 = C61
Radiotherapy treatment intent = radical
Treatment modality = external beam
First prescription treatment region = primary
Person stated gender = male

Numerator: Episodes in the denominator delivered using 19 or 20 fractions per prescription

Rectal metric 2a

Percentage of episodes of radical intent radiotherapy for rectal cancer which use a short course regimen

Overall trend, England

Rectal metric 2a: England percentage by 6 month period

Summary table

With 19,634 episodes entering into the analysis from the 1 January 2020 to 30 June 2024, the metric figures can be summarised below:

Data period	England overall (%)	Highest provider (%)*	Median provider (%)*	Number of providers (5 or more episodes)
2020 JAN - JUN	37.8	81.0	36.3	50
2020 JUL - DEC	29.5	85.7	22.2	49
2021 JAN - JUN	32.9	87.5	24.1	50
2021 JUL - DEC	31.8	77.8	24.7	50
2022 JAN - JUN	31.4	77.9	25.2	50
2022 JUL - DEC	32.9	84.6	26.4	50
2023 JAN - JUN	31.5	83.3	26.8	50
2023 JUL - DEC	31.3	88.2	24.3	48
2024 JAN - JUN	27.8	85.4	25.0	49

*Lowest, highest and median provider percentages are based on providers with 5 or more episodes in the data period.

Results by provider volume

Rectal metric 2a: Provider percentage by 6 month period

Metric methodology

Rationale: Radiotherapy delivered in the pre-operative setting in the management of locally advanced rectal cancer can be in the form of standard pre-operative short-course radiotherapy or long-course chemo-radiotherapy, or as part of a total neoadjuvant therapy approach with pre-operative chemotherapy. Wide variation exists in both the use and type of radiotherapy delivered in the management of rectal cancer across England.1

See RCR guidlines for full details.

Data sources: RTDS

Denominator: Episodes of radical intent external beam radiotherapy for rectal cancer

Radiotherapy tumour site = rectal, ICD10 = C18, C19, C20
Radiotherapy treatment intent = radical
Treatment modality = external beam

Numerator: Episodes in the denominator where the first prescription dose = 24-27Gy and first prescription fractions = 5

References

Morris EJA, Finan PJ, Spencer K, Geh I, Crellin A, Quirke P, Thomas JD, Lawton S, Adams R, Sebag-Montefiore D. Wide Variation in the Use of Radiotherapy in the Management of Surgically Treated Rectal Cancer Across the English National Health Service. Clin Oncol (R Coll Radiol). 2016. doi: 10.1016/j.clon.2016.02.002.

Lung metric 7a

Percentage of PS 0-1 stage 3 NSCLC treated with radical concurrent Chemo-RT

Overall trend, England

Lung 7a: England percentage by 6 month period

*This metric only includes episodes for cancer diagnoses up to December 2022 and so data is incomplete from January 2023 onwards.

Summary table

With 8,345 episodes entering into the analysis from the 1 January 2020 to 30 June 2024, the metric figures can be summarised below:

Data period*	England overall (%)	Lowest provider (%)**	Highest provider (%)**	Median provider (%)**	Number of providers (5 or more episodes)
2020 JAN - JUN	22.9	3.0	63.6	22.8	50
2020 JUL - DEC	25.3	4.3	58.1	26.1	49
2021 JAN - JUN	30.3	0.0	62.5	30.8	49
2021 JUL - DEC	33.4	0.0	71.4	34.8	47
2022 JAN - JUN	35.3	5.6	73.3	37.5	49
2022 JUL - DEC	32.2	0.0	83.3	32.5	50
2023 JAN - JUN	27.5	0.0	62.5	25.0	47
2023 JUL - DEC	14.0	0.0	33.3	14.3	27
2024 JAN - JUN	16.4	0.0	40.0	15.5	28

*This metric only includes episodes for cancer diagnoses up to December 2022 and so data is incomplete from January 2023 onwards.

**Lowest, highest and median provider percentages are based on providers with 5 or more episodes in the data period.

Results by provider volume

Lung 7a: Provider percentage by 6 month period

*This metric only includes episodes for cancer diagnoses up to December 2022 and so data is incomplete from January 2023 onwards.

Metric methodology

Rationale: Radical chemo-radiotherapy confers a significant survival benefit compared to sequential chemo-radiotherapy in locally advanced lung cancer.1, 2

See RCR guidlines for full details.

Data sources: RTDS, NCRD

Denominator: All episodes of external beam radiotherapy for PS 0-1 stage 3 NSCLC

NCRD detailed tumour site = Non-small cell lung cancer (morphology code not in 8002, 8041, 8042, 8043, 8044, 8045)
NCRD stage = 3
Performance status = 0-1
Treatment modality = external beam

Numerator: Of the denominator, episodes treated with radical concurrent chemo-radiotherapy

Episodes in the denominator where radiotherapy intent is radical and chemotherapy regimen start date is within +/- 3 days of radiotherapy treatment start date

References

O’Rourke N, Roqué I, Figuls M, Farré Bernadó N, Macbeth F. Concurrent chemoradiotherapy in non-small cell lung cancer. Cochrane Database Syst Rev 2010; 16: CD002140
Spiegel DR, Faivre-Finn C, Gray JE et al. Five-year survival outcomes from the PACIFIC trial: durvalumab after chemoradiotherapy in stage III non–small-cell lung cancer. J Clin Oncol 2022; 40: 1301–11

Head and neck metric 5a

Percentage of adjuvant radiotherapy treatments of head and neck mucosal cancers that start within 6 weeks of surgery

Overall trend, England

Head and neck metric 5a: England percentage by 6 month period

Summary table

With 7,027 episodes entering into the analysis from the 1 January 2020 to 30 June 2024, the metric figures can be summarised below:

Data period	England overall (%)	Highest provider (%)*	Median provider (%)*	Number of providers (5 or more episodes)
2020 JAN - JUN	27.7	71.4	20.6	42
2020 JUL - DEC	34.4	100.0	28.0	42
2021 JAN - JUN	29.2	80.0	24.1	42
2021 JUL - DEC	27.9	68.8	25.0	43
2022 JAN - JUN	18.4	75.0	13.5	43
2022 JUL - DEC	20.1	87.5	15.3	42
2023 JAN - JUN	14.6	80.0	10.0	42
2023 JUL - DEC	17.7	66.7	14.3	41
2024 JAN - JUN	13.8	65.0	9.5	41

*Lowest, highest and median provider percentages are based on providers with 5 or more episodes in the data period.

Results by provider volume

Head and neck metric 5a: Provider percentage by 6 month period

Episodes by week

Percentage of head and neck episodes starting radiotherapy treatment by weeks after surgery

Metric methodology

Rationale: Adjuvant radiotherapy after surgery for high-risk localised head and neck mucosal cancers has been shown to improve overall survival. A delay of more than 6 weeks after completion of surgery has been shown to be associated with a decrease in overall survival.

Data sources: RTDS, RCRD

Denominator: Episodes of radical intent radiotherapy for Head and Neck that start within 3 months of surgery

Radiotherapy and surgery tumour site = head and neck, ICD10 = C00-C14, C30-C32
Radiotherapy treatment intent = radical
Days between latest surgery and radiotherapy treatment start date = 0-90 (agreed upon definition of adjuvant radiotherapy to avoid inclusion of treatments for early recurrence)

Numerator: All episodes in the denominator where the number of days between latest surgery and radiotherapy start date is less than 42

Oesophago-gastric metric 1a

Percentage of episodes of radical intent radiotherapy for oesophago-gastric cancer which utilise IMRT

Overall trend, England

Oesophago-gastric metric 1a: England percentage by 6 month period

Summary table

With 6,779 episodes entering into the analysis from the 1 January 2020 to 30 June 2024, the metric figures can be summarised below:

Data period	England overall (%)	Lowest provider (%)*	Highest provider (%)*	Median provider (%)*	Number of providers (5 or more episodes)
2020 JAN - JUN	81.9	14.3	100.0	93.5	46
2020 JUL - DEC	85.4	0.0	100.0	97.0	40
2021 JAN - JUN	88.9	5.9	100.0	100.0	41
2021 JUL - DEC	87.3	0.0	100.0	98.8	44
2022 JAN - JUN	89.9	6.2	100.0	97.7	42
2022 JUL - DEC	90.5	12.5	100.0	100.0	46
2023 JAN - JUN	92.3	22.2	100.0	100.0	43
2023 JUL - DEC	91.5	33.3	100.0	100.0	42
2024 JAN - JUN	92.7	16.7	100.0	100.0	46

*Lowest, highest and median provider percentages are based on providers with 5 or more episodes in the data period.

Results by provider volume

Oesophago-gastric metric 1a: Provider percentage by 6 month period

Metric methodology

Rationale: IMRT techniques for radical radiotherapy for oesophago-gastric cancer (OG) helps deliver more accurate radiotherapy ensuring that the Planning Target Volume (PTV) receives as high a dose as desired in a uniform way whilst minimising the dose delivered to surrounding normal tissues. It is challenging to deliver a high radiation dose to the oesophagus or stomach without excessive radiation dose spillover to the heart, lung, kidneys, spleen and spinal cord. IMRT partially overcomes this challenge. There is no formal recommendation for IMRT use in current NICE guidance but a review of its use was recommended by NICE in line with stakeholder opinion in their Quality Standards Advisory Committee Meeting, 2018.

Data sources: RTDS

Denominator: Episodes of radical intent external beam radiotherapy for oesophago-gastric cancers

Radiotherapy tumour site = oesophago-gastric, ICD10 = C15, C16
Radiotherapy treatment intent = radical
Treatment modality = external beam

Numerator: Episodes in the denominator utilising IMRT (OPCS code = ‘X671’ or RTDS V6 specialist treatment = ‘Intensity-Modulated Radiation Therapy (IMRT) excluding more specific definitions’)

Anal metric 3a

Percentage of episodes where treatment was completed in the expected time

Overall trend, England

Anal 3a: England percentage by 6 month period

Summary table

With 5,330 episodes entering into the analysis from the 1 January 2020 to 30 June 2024, the metric figures can be summarised below:

Data period	England overall (%)	Lowest provider (%)*	Highest provider (%)*	Median provider (%)*	Number of providers (5 or more episodes)
2020 JAN - JUN	91.9	14.3	100.0	100.0	40
2020 JUL - DEC	93.1	80.0	100.0	94.1	38
2021 JAN - JUN	93.8	0.0	100.0	100.0	37
2021 JUL - DEC	93.5	77.8	100.0	100.0	42
2022 JAN - JUN	94.6	66.7	100.0	100.0	38
2022 JUL - DEC	96.2	75.0	100.0	100.0	38
2023 JAN - JUN	93.1	71.4	100.0	96.0	41
2023 JUL - DEC	94.2	80.0	100.0	96.4	39
2024 JAN - JUN	93.2	50.0	100.0	96.2	41

*Lowest, highest and median provider percentages are based on providers with 5 or more episodes in the data period.

Results by provider volume

Anal 3a: Provider percentage by 6 month period

Metric methodology

Rationale: Anal cancers have a short doubling time, meaning they grow rapidly, and studies have shown that an extension of overall treatment time leads to a decrease in local control. The RCR recommendation is that 95% of patients should not have a treatment length in excess of 2 days more than expected duration.

Data sources: RTDS

Denominator: Episodes of radical intent radiotherapy delivered for anal cancer

Radiotherapy tumour site = anal, ICD10 = C21
Radiotherapy treatment intent = radical

Numerator: Of the denominator, episodes where treatment completed in expected time

All episodes in the denominator where the difference in days between actual and expected treatment time is greater than 2
- Expected treatment time = max prescribed dose in episode / 5 * 7
- Actual treatment time = latest appointment date – earliest appointment date
- Difference = actual treatment time - expected treatment time

About the NDRS

The National Disease Registration Service (NDRS) is part of NHS England (NHSE). Its purpose is to collect, curate, quality-assure and analyse on patients with cancer, congenital anomalies, and rare diseases. It provides robust surveillance to monitor and detect changes in health and disease in the population. NDRS is a vital resource that helps researchers, healthcare professionals and policy makers make decisions about NHS services and the treatments people receive.

The NDRS includes:

the National Cancer Registration and Analysis Service (NCRAS) and
the National Congenital Anomaly and Rare Disease Registration Service (NCARDRS)

Healthcare professionals, researchers and policy makers use data to better understand population health and disease. The data is provided by patients and collected by the NHS as part of their care and support. The NDRS uses the data to help:

understand cancer, rare diseases, and congenital anomalies
improve diagnosis
plan NHS services
improve treatment
evaluate policy
improve genetic counselling

For queries relating to this document, please contact NDRS.datasets@nhs.net

Contacts and Resources at NDRS

The National Disease Registration Service (NDRS) are making every effort to support each NHS Trust in achieving the highest levels of data quality in their RTDS submission. To support this aim, the following resources are available:

Your NDRS Data Liaison Manager

Your Data Liaison Manager can provide extensive support to improve the quality of data submitted to the National Disease Registration Service. Please contact the RTDS Helpdesk: rtds.helpdesk@nhs.net for further details.

NDRS Data Hub and Website

A single point of access for all NDRS related information including cancer data collection, datasets, supporting tools, training materials and guidance documents: NDRS Data Hub.

CancerStats2

CancerStats2 is a secure reporting platform that is only available to organisations with a HSCN connection. The platform hosts a variety of RTDS dashboards, including the radiotherapy quality metrics dashboard, the dose and fractionation dashboard and regularly updated operational data. In addition to RTDS data, the platform features dashboards reporting for cancer incidence and mortality, molecular and genetics and systemic anti-cancer therapy. CancerStats2 platform enables key stakeholders to generate reports using NDRS data on a self-service basis. If you do not currently have access please contact the RTDS Helpdesk (rtds.helpdesk@nhs.net).

Patient acknowledgement

This work uses data that has been provided by patients and collected by the NHS as part of their care and support. The data is collated, maintained and quality assured by the National Cancer Registration and Analysis Service, which is part of NHS England.