Subject(s)
Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Humans , Lung , Lung Neoplasms/radiotherapy , Palliative CareABSTRACT
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.
Subject(s)
Lung Neoplasms/radiotherapy , Patient Care Planning , Peer Review, Health Care , Radiotherapy/standards , Adult , Aged , Aged, 80 and over , Humans , Middle Aged , Patient Care Planning/standards , Quality Assurance, Health CareABSTRACT
This paper reviews the use of hyperfractionated and/or accelerated radiation therapy in the curative treatment of non-small cell lung cancer, and explains the scientific rationale behind the development of these regimes. The indications, practicalities and economics of introducing them routinely are addressed. Novel radiotherapy techniques are further discussed in the context of current developments and on-going clinical trials.
