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Murphy L, Cantwell J, Chard J, Cheuk R, Harrington C, Hindson B, Salkeld A, Saran F, Wheeler G, Wiltshire K, Ahern V. Quality improvement in paediatric radiation oncology through peer review. J Med Imaging Radiat Oncol 2020; 64:697-703. [PMID: 32715642 DOI: 10.1111/1754-9485.13092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/16/2020] [Accepted: 07/04/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Around 300 children in Australia and New Zealand (ANZ) undergo a course of radiation treatment (RT) each year. A fortnightly videoconference for radiation oncologists managing children started in 2013. We conducted an audit of the videoconference to assess its influence on the care of children who receive RT in ANZ. METHODS De-identified data from minutes (August 2013-December 2019) were analysed retrospectively using three categories: meeting participation, case presentations and management decisions. RESULTS There were 119 meetings and 334 children discussed over the six-year audit period with regular attendance from four of 11 centres treating children in ANZ. Most cases (80%) were discussed prior to RT. A change in the overall management plan was recommended for around one in eight patients (35/334, 13%). RT plan reviews were performed in 79 cases (23%). Adjustments were made to the target volume contours or treatment plan in 8% (6/79). CONCLUSION Increasing the frequency of the meeting to weekly and compliant with the RANZCR Peer Review Audit Tool has the capacity to review all paediatric RT patients in ANZ prior to RT and initiate changes for as many as one in eight children treated by RT each year. The meeting should be considered a core component necessary to maintain expertise in paediatric RT in all centres providing RT for children in ANZ while also acting as a proton referral panel as more children are referred abroad for proton therapy before the Australian Bragg Centre for Proton Therapy opens in Adelaide in 2024.
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Affiliation(s)
- Laura Murphy
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Jessica Cantwell
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Jennifer Chard
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Robyn Cheuk
- Cancer Care Services - Department of Radiation Oncology, Royal Brisbane and Womens' Hospital, Brisbane, Queensland, Australia.,Radiation Oncology PA Raymond Terrace, Cancer Services Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia
| | - Christopher Harrington
- Canterbury Regional Cancer and Haematology Service, Christchurch Hospital, Christchurch, New Zealand
| | - Ben Hindson
- Canterbury Regional Cancer and Haematology Service, Christchurch Hospital, Christchurch, New Zealand
| | - Alison Salkeld
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Sydney University, Sydney, New South Wales, Australia
| | - Frank Saran
- Auckland City Hospital, Auckland, New Zealand
| | - Greg Wheeler
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Kirsty Wiltshire
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Verity Ahern
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Sydney University, Sydney, New South Wales, Australia
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Hwang EJ, Gorayski P, Le H, Hanna GG, Kenny L, Penniment M, Buck J, Thwaites D, Ahern V. Particle therapy toxicity outcomes: A systematic review. J Med Imaging Radiat Oncol 2020; 64:725-737. [PMID: 32421259 DOI: 10.1111/1754-9485.13036] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 02/06/2023]
Abstract
Owing to its physical properties, particle therapy (PT), including proton beam therapy (PBT) and carbon ion therapy (CIT), can enhance the therapeutic ratio in radiation therapy. The major factor driving PT implementation is the reduction in exit and integral dose compared to photon plans, which is expected to translate to reduced toxicity and improved quality of life. This study extends the findings from a recent systematic review by the current authors which concentrated on tumour outcomes for PT, to now examine toxicity as a separate focus. Together, these reviews provide a comprehensive collation of the evidence relating to PT outcomes in clinical practice. Three major databases were searched by two independent researchers, and evidence quality was classified according to the National Health and Medical Research Council evidence hierarchy. One hundred and seventy-nine studies were included. Most demonstrated acceptable and favourable toxicity results. Comparative evidence reported reduced morbidities and improvement in quality of life in head and neck, paediatrics, sarcomas, adult central nervous system, gastrointestinal, ocular and prostate cancers compared to photon radiotherapy. This suggestion for reduced morbidity must be counterbalanced by the overall low quality of evidence. A concerted effort in the design of appropriate comparative clinical trials is needed which takes into account integration of PT's pace of technological advancements, including evolving delivery techniques, image guidance availability and sophistication of planning algorithms.
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Affiliation(s)
- Eun Ji Hwang
- Department of Radiation Oncology, Sydney West Radiation Oncology Network, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.,Medicine, Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
| | - Peter Gorayski
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Gerard G Hanna
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum, Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Liz Kenny
- Department of Radiation Oncology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Michael Penniment
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jacqueline Buck
- Department of Radiation Oncology, Sydney West Radiation Oncology Network, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia
| | - David Thwaites
- Department of Radiation Oncology, Sydney West Radiation Oncology Network, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.,Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
| | - Verity Ahern
- Department of Radiation Oncology, Sydney West Radiation Oncology Network, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia
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