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Shao Y, Chen H, Wang H, Feng A, Huang Y, Kong Q, Xu Z. Isotoxic investigation of 18F-FDG PET/CT-guided dose escalation with intensity-modulated radiotherapy for LA-NSCLC. Int J Radiat Biol 2021; 97:1641-1648. [PMID: 34597214 DOI: 10.1080/09553002.2021.1987557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE This research compared differences of dosimetric and biological parameters between PET/CT-guided isotoxic SIB-IMRT plans and conventional radiotherapy plans for patients with LA-NSCLC, and it also evaluated the factors that affect dose escalation. MATERIALS AND METHODS This study consisted of a retrospective cohort of thirty patients with IIIA-IIIB NSCLC. SIB-IMRT (Plan_iso) and conventional radiotherapy (Plan_primary) plans were generated using auto-planning. Dosimetric parameters such as mean lung dose (MLD) and other indicators were compared. Tumor control probability (TCP) of PTV and normal tissue complication probability (NTCP) of total lung, heart, esophagus, and spinal cord were calculated. The relationships between dose escalation and 3 D length of PTV and other factors were analyzed. Paired-samples t-test, Mann-Whitney U test, and Chi-Square test were performed for comparisons between datasets. A P < .05 was considered statistically significant. RESULTS The dosimetric parameters of PTV in Plan_iso were higher than those of PTV in Plan_primary, and there were significant differences (p < .05). Compared with Plan_primary, Plan_iso slightly increased dosimetric parameters of the total lung, heart, spinal cord, esophagus, and MUs. The absolute differences were small. TCPs of PTV in Plan_iso were significantly higher than those in Plan_primary. NTCPs of the total lung, esophagus, and spinal cord in Plan_iso were higher than those in Plan_primary. There were significant differences, but the absolute differences were small. NTCP of heart in Plan_iso was slightly higher than that in Plan_primary, but there was no statistical difference. CONCLUSIONS For LA-NSCLC, the SIB based on isotoxic radiotherapy can significantly increase TCP under the premise that the toxicity of OARs is comparable.
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Affiliation(s)
- Yan Shao
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Institute of Modern Physics, Fudan University, Shanghai, China
| | - Hua Chen
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Institute of Modern Physics, Fudan University, Shanghai, China
| | - Hao Wang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Institute of Modern Physics, Fudan University, Shanghai, China
| | - Aihui Feng
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Huang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qing Kong
- Institute of Modern Physics, Fudan University, Shanghai, China
| | - Zhiyong Xu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Shrimali RK, Chakraborty S, Bhattacharyya T, Mallick I, Achari RB, Prasath S, Arun B, Mahata A, Vidhya Shree M, Vishnupriya E, Chatterjee S. Development and validation of a decision support tool to select IMRT as radiotherapy treatment planning modality for patients with locoregionally advanced non-small cell lung cancers (NSCLC). Br J Radiol 2018; 92:20180431. [PMID: 30387364 DOI: 10.1259/bjr.20180431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: Radiation planning for locally-advanced non-small cell lung cancer (NSCLC) can be time-consuming and iterative. Many cases cannot be planned satisfactorily using multisegment three-dimensional conformal radiotherapy (3DCRT). We sought to develop and validate a predictive model which could estimate the probability that acceptable target volume coverage would need intensity modulated radiotherapy (IMRT). METHODS: Variables related to the planning target volume (PTV) and topography were identified heuristically. These included the PTV, it's craniocaudal extent, the ratio of PTV to total lung volume, distance of the centroid of the PTV from the spinal canal, and the extent PTV crossed the midline. Metrics were chosen such that they could be measured objectively, quickly and reproducibly. A logistic regression model was trained and validated on 202 patients with NSCLC. A group of patients who had both complex 3DCRT and IMRT planned was then used to derive the utility of the use of such a model in the clinic based on the time taken for planning such complex 3DCRT. RESULTS: Of the 202 patients, 93 received IMRT, as they had larger volumes crossing midline. The final model showed a good rank discrimination (Harrell's C-index 0.84) and low calibration error (mean absolute error of 0.014). Predictive accuracy in an external dataset was 92%. The final model was presented as a nomogram. Using this model, the dosimetrist can save a median planning time of 168 min per case. CONCLUSION: We developed and validated a data-driven, decision aid which can reproducibly determine the best planning technique for locally-advanced NSCLC. ADVANCES IN KNOWLEDGE: Our validated, data-driven decision aid can help the planner to determine the need for IMRT in locally advanced NSCLC saving significant planning time in the process.
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Affiliation(s)
- Raj Kumar Shrimali
- 1 Department of Radiation Oncology, Tata Medical Center , Rajarhat, Kolkata , India
| | - Santam Chakraborty
- 1 Department of Radiation Oncology, Tata Medical Center , Rajarhat, Kolkata , India
| | - Tapesh Bhattacharyya
- 1 Department of Radiation Oncology, Tata Medical Center , Rajarhat, Kolkata , India
| | - Indranil Mallick
- 1 Department of Radiation Oncology, Tata Medical Center , Rajarhat, Kolkata , India
| | - Rimpa Basu Achari
- 1 Department of Radiation Oncology, Tata Medical Center , Rajarhat, Kolkata , India
| | - Sriram Prasath
- 1 Department of Radiation Oncology, Tata Medical Center , Rajarhat, Kolkata , India
| | - B Arun
- 1 Department of Radiation Oncology, Tata Medical Center , Rajarhat, Kolkata , India
| | - Anurupa Mahata
- 1 Department of Radiation Oncology, Tata Medical Center , Rajarhat, Kolkata , India
| | - M Vidhya Shree
- 1 Department of Radiation Oncology, Tata Medical Center , Rajarhat, Kolkata , India
| | - E Vishnupriya
- 1 Department of Radiation Oncology, Tata Medical Center , Rajarhat, Kolkata , India
| | - Sanjoy Chatterjee
- 1 Department of Radiation Oncology, Tata Medical Center , Rajarhat, Kolkata , India
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Barrett S, Hanna GG, Marignol L. An overview on personalisation of radiotherapy prescriptions in locally advanced non-small cell lung cancer: Are we there yet? Radiother Oncol 2018; 128:520-533. [PMID: 29908871 DOI: 10.1016/j.radonc.2018.05.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/21/2018] [Accepted: 05/28/2018] [Indexed: 12/25/2022]
Abstract
Standard of care radiotherapy in LA-NSCLC is 60-66 Gy in 30-33 fractions. However outcomes for these patients are poor with 5-year survival in the range of 10-20%. Randomised controlled trials have shown that dose escalation in a linear fashion does not improve outcomes for all patients, thus there is a need to tailor the prescription to the individual patient. This review assesses the strategies published to personalise the radiation therapy dose prescription in LA-NSCLC. A systematic and scoping search of the literature was performed to identify studies that met the inclusion criteria. 19 relevant studies were identified ranging from prospective clinical trials to mathematically modelled concept studies. Heterogeneity existed between all clinical studies. Nine heterogeneous publications proposed methodology to adapt the dose prescription to the individual patient. A number of encouraging strategies have been identified but fall short of the evidence level required to influence clinical practice.
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Affiliation(s)
- Sarah Barrett
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, Dublin, Ireland.
| | - Gerard G Hanna
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, United Kingdom.
| | - Laure Marignol
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, Dublin, Ireland.
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The potential for increased tumor control probability in non-small cell lung cancer with a hypofractionated integrated boost to the gross tumor volume. Med Dosim 2018; 43:352-357. [PMID: 29289456 DOI: 10.1016/j.meddos.2017.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 11/08/2017] [Accepted: 11/21/2017] [Indexed: 12/25/2022]
Abstract
Treatment outcomes in locally advanced non-small cell lung cancer (NSCLC) to date have been poor, with normal tissue toxicity often limiting the dose that can be delivered to the tumor. Treatment intensification in NSCLC via targeted dose escalation with modern delivery techniques may offer the potential for a significant increase in tumor control probability (TCP) without a clinically significant increase in organ-at-risk (OAR) toxicity. In this planning study, 20 patients were re-planned with a volumetric modulated arc therapy (VMAT) and an inhomogeneous dose distribution with iteratively escalated doses to the gross tumor volume (iGTV) (composite GTV across multiple 4-dimensional computed tomography [4DCT] phases) in a series of 20 fraction regimes. For each plan OAR doses, target coverage and predicted TCPs were collected and compared with homogenous 3-dimensional (3D) and VMAT plans, as well as with each other. In 70% of patients, it was possible to escalate to 75 Gy in 20 fractions within OAR tolerances, opening the possibility of treating these patients to a biological effective dose (BED) of 103.1 Gy10. This planning study forms the basis of a clinical trial INTENSE (Inhomogeneous Targeted Dose Escalation in Non-Small CEll Lung Cancer), CTRIAL 15-47.
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Hong CS, Ju SG, Ahn YC, Yoo GS, Noh JM, Oh D, Chung K, Pyo H, Jo K. Normal lung sparing Tomotherapy technique in stage III lung cancer. Radiat Oncol 2017; 12:167. [PMID: 29110732 PMCID: PMC5674800 DOI: 10.1186/s13014-017-0905-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/14/2017] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Radiation pneumonitis (RP) has been a challenging obstacle in treating stage III lung cancer patients. Beam angle optimization (BAO) technique for Tomotherapy was developed to reduce the normal lung dose for stage III non-small cell lung cancer (NSCLC). Comparative analyses on plan quality by 3 different Intensity-modulated radiation therapy (IMRT) methods with BAO were done. MATERIALS AND METHODS Ten consecutive stage IIIB NSCLC patients receiving linac-based static IMRT (L-IMRT) with total 66 Gy in 33 fractions to the PTV were selected. Two additional Tomotherapy-based IMRT plans (helical beam (TH-IMRT) and static beam (TD-IMRT)) were generated on each patient. To reduce the normal lung dose, Beam angles were optimized by using complete and directional block functions in Tomotherapy based on knowledge based statistical analysis. Plan quality was compared with target coverage, normal organ sparing capability, and normal tissue complication probability (NTCP). Actual beam delivery times and risk of RP related with planning target volume (PTV) were also evaluated. RESULTS The best PTV coverage measured by conformity index and homogeneity index was achievable by TH-IMRT (0.82 and 1.06), followed by TD-IMRT (0.81 and 1.07) and L-IMRT (0.75 and 1.08). Mean lung dose was the lowest in TH-IMRT plan followed by TD-IMRT and L-IMRT, all of which were ≤20 Gy. TH-IMRT plan could significantly lower the lung volumes receiving low to medium dose levels: V5~30 when compared to L-IMRT plan; and V5~20 when compared to TD-IMRT plan, respectively. TD-IMRT plan was significantly better than L-IMRT with respects to V20 and V30 and there was no significant difference with respect to V40 among three plans. The NTCP of the lung was the lowest in TH-IMRT plan, followed by TD-IMRT and L-IMRT (6.42% vs. 6.53% vs. 8.11%). Beam delivery time was the shortest in TD-IMRT plan followed by L-IMRT. As PTV length increased, NTCP and Mean lung dose proportionally increased significantly in all three plans. CONCLUSION Advantageous profiles by TH-IMRT could be achieved by BAO by complete and directional block functions. Current observation could help radiation oncologists to make wise selection of IMRT method for stage IIIB NSCLC.
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Affiliation(s)
- Chae-Seon Hong
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea
| | - Sang Gyu Ju
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea.
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea.
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea.
| | - Gyu Sang Yoo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea
| | - Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea
| | - Kwangzoo Chung
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea
| | - Hongryull Pyo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea
| | - Kwanghyun Jo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea
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Bainbridge HE, Menten MJ, Fast MF, Nill S, Oelfke U, McDonald F. Treating locally advanced lung cancer with a 1.5T MR-Linac - Effects of the magnetic field and irradiation geometry on conventionally fractionated and isotoxic dose-escalated radiotherapy. Radiother Oncol 2017; 125:280-285. [PMID: 28987747 PMCID: PMC5710994 DOI: 10.1016/j.radonc.2017.09.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/21/2017] [Accepted: 09/09/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE This study investigates the feasibility and potential benefits of radiotherapy with a 1.5T MR-Linac for locally advanced non-small cell lung cancer (LA NSCLC) patients. MATERIAL AND METHODS Ten patients with LA NSCLC were retrospectively re-planned six times: three treatment plans were created according to a protocol for conventionally fractionated radiotherapy and three treatment plans following guidelines for isotoxic target dose escalation. In each case, two plans were designed for the MR-Linac, either with standard (∼7mm) or reduced (∼3mm) planning target volume (PTV) margins, while one conventional linac plan was created with standard margins. Treatment plan quality was evaluated using dose-volume metrics or by quantifying dose escalation potential. RESULTS All generated treatment plans fulfilled their respective planning constraints. For conventionally fractionated treatments, MR-Linac plans with standard margins had slightly increased skin dose when compared to conventional linac plans. Using reduced margins alleviated this issue and decreased exposure of several other organs-at-risk (OAR). Reduced margins also enabled increased isotoxic target dose escalation. CONCLUSION It is feasible to generate treatment plans for LA NSCLC patients on a 1.5T MR-Linac. Margin reduction, facilitated by an envisioned MRI-guided workflow, enables increased OAR sparing and isotoxic target dose escalation for the respective treatment approaches.
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Affiliation(s)
- Hannah E Bainbridge
- Department of Radiotherapy at The Royal Marsden NHS Foundation Trust, United Kingdom; The Institute of Cancer Research, United Kingdom.
| | - Martin J Menten
- Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom.
| | - Martin F Fast
- Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Simeon Nill
- Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Uwe Oelfke
- Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Fiona McDonald
- Department of Radiotherapy at The Royal Marsden NHS Foundation Trust, United Kingdom; The Institute of Cancer Research, United Kingdom
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Normal tissue considerations and dose-volume constraints in the moderately hypofractionated treatment of non-small cell lung cancer. Radiother Oncol 2016; 119:423-31. [PMID: 27084120 DOI: 10.1016/j.radonc.2016.03.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 02/15/2016] [Accepted: 03/11/2016] [Indexed: 12/25/2022]
Abstract
Hypofractionated radiation therapy (RT) regimes in non-small cell lung cancer (NSCLC) have become increasingly popular with a number of international trials currently underway. The majority of the dose-volume-constraints (DVCs) published in the literature refer to conventional 2Gy per fraction deliveries. Here relevant organs-at-risk (OARs) are identified and available dose-volume constraint data discussed and summarised for moderately hypofractionated NSCLC regimes. The OARs examined include lung, brachial plexus, heart, oesophagus, airway and spinal cord. Where available the toxicity rates are also reported with all data summarised tabulated to aid its use in the clinic.
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Chargari C, Magne N, Guy JB, Rancoule C, Levy A, Goodman KA, Deutsch E. Optimize and refine therapeutic index in radiation therapy: Overview of a century. Cancer Treat Rev 2016; 45:58-67. [DOI: 10.1016/j.ctrv.2016.03.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/25/2016] [Accepted: 03/01/2016] [Indexed: 12/20/2022]
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Shrimali RK, Mahata A, Reddy GD, Franks KN, Chatterjee S. Pitfalls and Challenges to Consider before Setting up a Lung Cancer Intensity-modulated Radiotherapy Service: A Review of the Reported Clinical Experience. Clin Oncol (R Coll Radiol) 2015; 28:185-97. [PMID: 26329504 DOI: 10.1016/j.clon.2015.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 05/27/2015] [Accepted: 08/12/2015] [Indexed: 12/25/2022]
Abstract
Intensity-modulated radiotherapy (IMRT) is being increasingly used for the treatment of non-small cell lung cancer (NSCLC), despite the absence of published randomised controlled trials. Planning studies and retrospective series have shown a decrease in known predictors of lung toxicity (V20 and mean lung dose) and the maximum spinal cord dose. Potential dosimetric advantages, accessibility of technology, a desire to escalate dose or a need to meet normal organ dose constraints are some of the factors recognised as supporting the use of IMRT. However, IMRT may not be appropriate for all patients being treated with radical radiotherapy. Unique problems with using IMRT for NSCLC include organ and tumour motion because of breathing and the potential toxicity from low doses of radiotherapy to larger amounts of lung tissue. Caution should be exercised as there is a paucity of prospective data regarding the efficacy and safety of IMRT in lung cancer when compared with three-dimensional conformal radiotherapy and IMRT data from other cancer sites should not be extrapolated. This review looks at the use of IMRT in NSCLC, addresses the challenges and highlights the potential benefits of using this complex radiotherapy technique.
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Affiliation(s)
- R K Shrimali
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India.
| | - A Mahata
- Medical Physics, Tata Medical Center, Kolkata, India
| | - G D Reddy
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - K N Franks
- Leeds Cancer Centre, St James's University Hospital, Leeds, UK
| | - S Chatterjee
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
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Rooney KP, McAleese J, Crockett C, Harney J, Eakin RL, Young VAL, Dunn MA, Johnston RE, Hanna GG. The Impact of Colleague Peer Review on the Radiotherapy Treatment Planning Process in the Radical Treatment of Lung Cancer. Clin Oncol (R Coll Radiol) 2015; 27:514-8. [PMID: 26150375 DOI: 10.1016/j.clon.2015.05.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 05/14/2015] [Accepted: 05/28/2015] [Indexed: 12/25/2022]
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.
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Affiliation(s)
- K P Rooney
- Cancer Centre, Belfast City Hospital, Belfast, UK.
| | - J McAleese
- Cancer Centre, Belfast City Hospital, Belfast, UK
| | - C Crockett
- Cancer Centre, Belfast City Hospital, Belfast, UK
| | - J Harney
- Cancer Centre, Belfast City Hospital, Belfast, UK
| | - R L Eakin
- Cancer Centre, Belfast City Hospital, Belfast, UK
| | - V A L Young
- Cancer Centre, Belfast City Hospital, Belfast, UK
| | - M A Dunn
- Cancer Centre, Belfast City Hospital, Belfast, UK
| | - R E Johnston
- Cancer Centre, Belfast City Hospital, Belfast, UK
| | - G G Hanna
- Cancer Centre, Belfast City Hospital, Belfast, UK; Centre for Cancer Research and Cell Biology, Queen's University of Belfast, Belfast, UK
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Price A. Intensity-Modulated Radiotherapy, Not 3 Dimensional Conformal, Is the Preferred Technique for Treating Locally Advanced Disease With High-Dose Radiotherapy: The Argument Against. Semin Radiat Oncol 2015; 25:117-21. [DOI: 10.1016/j.semradonc.2014.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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