The Canadian National System for Incident Reporting in Radiation Treatment (NSIR-RT) Taxonomy.

PURPOSE: Incident investigation, reporting, and learning are core elements of quality improvement in radiation treatment. This report describes the development of a Canadian National System for Incident Reporting in Radiation Treatment (NSIR-RT), focusing especially on the taxonomy. METHODS AND MATERIALS: The NSIR-RT was developed to provide a framework in Canada for reporting and analyzing radiation treatment incidents. A key objective was to assure compatibility with other international reporting systems to facilitate future information exchange. The Canadian community was engaged at every step of the development process through Delphi consensus building and inter-user agreement testing to promote awareness of the system and motivate broad-based utilization across the country. RESULTS: The final taxonomy was comprised of 6 data groups (impact, discovery, patient, details, treatment delivery, and investigation) and 33 data categories with predefined menu options. There was a high level agreement within the Canadian community about the final suite of data categories, and broad alignment of these categories with the World Health Organization and other American and European radiation treatment incident classifications. CONCLUSIONS: The Canadian NSIR-RT taxonomy will be implemented as an online, web-based reporting and analysis system. It is expected that the taxonomy will evolve and mature over time to meet the changing needs of the Canadian radiation treatment community and support radiation treatment incident learning on a global scale.

Thoracic reirradiation for lung cancer: a literature review and practical guide.

INTRODUCTION: Approximately half of all patients with lung cancer (LC) experience locoregional failure after initial treatment. Historically, thoracic reirradiation (ReRT) has been limited by toxicity concerns and lack of robust evidence. Our objective was to perform a systematic literature review regarding ReRT. METHODS: Search of the English-language literature related to best-practice thoracic ReRT (Medline and Embase) was performed. Clinical practice guidelines and consensus statements were also reviewed. Data was abstracted regarding patient, tumour and radiotherapy characteristics; response rate; overall survival (OS); and toxicity. In addition to descriptive analysis, Spearman's test explored relationships between RT dose and OS. RESULTS: A total of 379 patients (89% non-small cell; 11% small cell LC) retreated with radical or palliative intent have been described by 13 publications (1982-2014). A total of 86% were symptomatic at the time of ReRT; rate of symptom improvement was 69%. Range of reported median survivals (MS) was 3-15 months. Median initial (59 Gy; range, 12-80 Gy), ReRT (36 Gy; range, 12-70 Gy) and combined dose (86 Gy; range, 58-120 Gy) significantly correlated with OS, with Spearman's rho values of 0.85 (P=0.002), 0.72 (P=0.006), and 0.88 (P=0.001) respectively. Toxicity after ReRT was reported in 17% (esophagitis) and 12% (pneumonitis), with RT complications contributing to 2% of deaths. CONCLUSIONS: Despite heterogeneity of patient cohorts, RT techniques and duration of follow-up, ReRT appears to be a feasible option for recurrent thoracic disease. Treatment guidelines derived from this data will guide clinical decision-making for both radical- and palliative-intent ReRT.