Prospective Qualitative and Quantitative Analysis of Real-Time Peer Review Quality Assurance Rounds Incorporating Direct Physical Examination for Head and Neck Cancer Radiation Therapy
Prospective Qualitative and Quantitative Analysis of Real-Time Peer Review Quality Assurance Rounds Incorporating Direct Physical Examination for Head and Neck Cancer Radiation Therapy
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DOI：
10.1016/j.ijrobp.2016.11.019
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发表时间：
2017-07-01
影响因子：
7
通讯作者：
Rosenthal, David I.
中科院分区：
文献类型：
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作者：
Cardenas, Carlos E.;Mohamed, Abdallah S. R.;Rosenthal, David I.
目的：我们的部门有一个长期建立的全面质量保证（QA）规划诊所接受放射治疗（RT）的头颈癌患者。我们的目的是评估实时同行评议QA过程的影响，定量和定性的放射治疗计划的变化，在时代的调强放疗（IMRT）。方法和材料：前瞻性数据为85例接受头颈部调强放疗谁提出了在一个双周QA诊所后，模拟和轮廓收集。使用标准数据收集表记录在此过程中所做的更改。在QA之前保存由治疗主治医生批准的原始QA前临床靶体积（CTV），并与QA后共识CTV进行比较。根据预定义的标准进行定性评估。计算每个CTV水平的骰子相似系数（DSC）和其他体积重叠指标，并用于定量比较。根据重叠的程度，将更改分为主要、次要和次要更改。失败的模式进行了分析，并与计划changes.Results：所有85例患者进行了检查，至少有1个头部和颈部亚专科放射肿瘤学家谁不是治疗主治医师; 80（94%）进行了检查，由>= 3教员。在12名患者（14%）中发现了新的体格检查临床结果，导致重大计划变更。定量DSC分析显示CTV 1（0.94 +/- 0.10）轮廓的一致性显著优于CTV 2（0.82 +/- 0.25）和CTV 3（0.86 +/- 0.2）轮廓（分别为P=.0002和P=.03;配对Wilcoxon检验）。当考虑所有CTV水平时，治疗主治放射肿瘤学家的经验显著影响DSC值（P= 0.012;配对Wilcoxon文本）。平均随访时间为38个月后，只有10例（12%）局部复发，区域复发，或两者兼而有之，主要是在中央高剂量areas.Conclusions：综合同行评审规划诊所是一个重要组成部分的调强放射治疗QA，导致三分之一的研究人群的重大变化。该过程确保了与靶点定义相关的安全性，并导致了有利的疾病控制特征，没有可识别的可归因于几何遗漏或描绘错误的复发。(C)2016 Elsevier Inc. All rights reserved.
Purpose: 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 a real-time peer review QA process on the quantitative and qualitative radiation therapy plan changes in the era of intensity modulated RT (IMRT).Methods and Materials: Prospective data for 85 patients undergoing head and neck IMRT who 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 pre-QA clinical target volumes (CTVs) approved by the treating-attending physicians were saved before QA and compared with post-QA consensus CTVs. Qualitative assessment was done according to predefined criteria. Dice similarity coefficients (DSC) and other volume overlap metrics were calculated for each CTV level and were used for quantitative comparison. Changes are categorized as major, minor, and trivial according to the degree of overlap. Patterns of failure were analyzed and correlated to plan changes.Results: All 85 patients were examined by at least 1 head and neck subspecialist radiation oncologist who was not the treating-attending physician; 80 (94%) were examined by >= 3 faculty members. 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 than in CTV2 (0.82 +/- 0.25) and CTV3 (0.86 +/- 0.2) contours (P=.0002 and P=.03, respectively; matched-pair Wilcoxon test). The experience of the treating-attending radiation oncologist significantly affected DSC values when all CTV levels were considered (P=.012; matched-pair Wilcoxon text). After a median follow-up time of 38 months, only 10 patients (12%) had local recurrence, regional recurrence, or both, mostly in central high-dose areas.Conclusions: Comprehensive 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 profiles, with no identifiable recurrences attributable to geometric misses or delineation errors. (C) 2016 Elsevier Inc. All rights reserved.