The Impact of Colleague Peer Review on the Radiotherapy Treatment Planning Process in the Radical Treatment of Lung Cancer

Abstract Aims Modern radiotherapy uses techniques to reliably identify tumour and reduce target volume margins. However, this can potentially lead to an increased risk of geographic miss. One source of error is the accuracy of target volume delineation (TVD). Colleague peer review (CPR) of all curat...

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Bibliographic Details
Published in:Clinical oncology (Royal College of Radiologists (Great Britain)) 2015-09, Vol.27 (9), p.514-518
Main Authors: Rooney, K.P, McAleese, J, Crockett, C, Harney, J, Eakin, R.L, Young, V.A.L, Dunn, M.A, Johnston, R.E, Hanna, G.G
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Hematology, Oncology and Palliative Medicine
Humans
Lung Neoplasms - radiotherapy
Middle Aged
Non-small cell lung cancer
Patient Care Planning - standards
peer review
Peer Review, Health Care
quality assurance
Quality Assurance, Health Care
Radiology
radiotherapy
Radiotherapy - standards
target volume delineation
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Summary:Abstract Aims Modern radiotherapy uses techniques to reliably identify tumour and reduce target volume margins. However, this can potentially lead to an increased risk of geographic miss. One source of error is the accuracy of target volume delineation (TVD). Colleague peer review (CPR) of all curative-intent lung cancer plans has been mandatory in our institution since May 2013. At least two clinical oncologists review plans, checking treatment paradigm, TVD, prescription dose tumour and critical organ tolerances. We report the impact of CPR in our institution. Materials and methods Radiotherapy treatment plans of all patients receiving radical radiotherapy were presented at weekly CPR meetings after their target volumes were reviewed and signed off by the treating consultant. All cases and any resultant change to TVD (including organs at risk) or treatment intent were recorded in our prospective CPR database. The impact of CPR over a 13 month period from May 2013 to June 2014 is reported. Results One hundred and twenty-two patients (63% non-small cell lung carcinoma, 17% small cell lung carcinoma and 20% ‘clinical diagnosis’) were analysed. On average, 3.2 cases were discussed per meeting (range 1–8). CPR resulted in a change in treatment paradigm in 3% (one patient proceeded to induction chemotherapy, two patients had high-dose palliative radiotherapy). Twenty-one (17%) had a change in TVD and one (1%) patient had a change in dose prescription. In total, 6% of patients had plan adjustment after review of dose volume histogram. Conclusion The introduction of CPR in our centre has resulted in a change in a component of the treatment plan for 27% of patients receiving curative-intent lung radiotherapy. We recommend CPR as a mandatory quality assurance step in the planning process of all radical lung plans.
ISSN:0936-6555
1433-2981
DOI:10.1016/j.clon.2015.05.010