Prospective Qualitative and Quantitative Analysis of Real-time Peer Review Quality Assurance Rounds Incorporating Direct Physical Examination for Head and Neck Cancer Radiation Therapy

Publication date: Available online 19 November 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Carlos E. Cardenas, Abdallah S.R. Mohamed, Randa Tao, Andrew J.R. Wong, Musaddiq J. Awan, Shirly Kuruvila, Michalis Aristophanous, G. Brandon Gunn, Jack Phan, Beth M. Beadle, Steven J. Frank, Adam S. Garden, William H. Morrison, Clifton David Fuller, David I. Rosenthal
Purpose/Objective(s)Our department has a long established comprehensive quality assurance (QA) planning clinic for patients undergoing radiation therapy (RT) for head-and-neck cancer. Our aim is to assess the impact of real-time peer review QA process on the quantitative and qualitative radiotherapy plan changes in the era of IMRT.Materials/MethodsProspective data for 85 patients undergoing head-and-neck IMRT presented at a biweekly QA clinic after simulation and contouring were collected. A standard data collection form was used to document alterations made during this process. The original treating-attending-approved pre-QA clinical target volumes (CTVs) were saved before QA and compared to post-QA consensus CTVs. Qualitative assessment was done using a pre-defined criteria. Dice similarity coefficients (DSC) and other volume overlap metrics were calculated for each CTV level and used for quantitative comparison. Changes are categorized as major, minor, and trivial per the degree of overlap. Patterns of failure were analyzed and correlated to plan changes.ResultsAll 85 patients were examined by at least one non-treating-attending head-and-neck sub-specialist radiation oncologist; 80 (94%) were examined by ≥3 faculty. New clinical findings on physical examination were found in 12 patients (14%) leading to major plan changes. Quantitative DSC analysis revealed significantly better agreement in CTV1 (0.94±0.10) contours compared to CTV2 (0.82±0.25) and CTV3 (0.86±0.2) contours (p=0.0002 and p=0.03, respectively; matched-pair Wilcoxon). Treating-attending radiation oncologist experience significantly affected DSC values when considering all CTV levels (p=.012; matched-pair Wilcoxon). After median follow-up of 38 months, only 10 patients (12%) had local and/or regional recurrence mostly in central high-dose areas.ConclusionsComprehensive peer review planning clinic is an essential component of IMRT QA that led to major changes in one third of the study population. This process ensured safety related to target definition and led to favorable disease control profile, with no identifiable recurrences attributable to geometric misses or delineation error.



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