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TU_28_3084 - Development of Best Practices of Peer Review in Lung Radiation Therapy

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

Development of Best Practices of Peer Review in Lung Radiation Therapy
A. Swaminath1, B. P. Yaremko2, L. Khan3, C. Simniceanu4, and M. D. Brundage5; 1Juravinski Cancer Centre, Hamilton, ON, Canada, 2London Health Sciences Centre, London, ON, Canada, 3University of Toronto, Toronto, ON, Canada, 4Cancer Care Ontario, Toronto, ON, Canada, 5Cancer Care and Epidemiology, Queen’s Cancer Research Institute, Kingston, ON, Canada

Purpose/Objective(s): Given the increasing complexity in lung radiation therapy (RT), peer review (PR) is an important component in ensuring high quality and consistent RT plans. However there are inconsistencies in the extent, timing, and minimum requirements for PR across centres. We sought to develop guidelines of best practices for PR in curative lung RT through a Pan-Canadian expert consensus process.

Materials/Methods: A modified Delphi process was conducted. A literature review was first carried out to define important elements for PR with respect to target delineation, organs-at-risk (OAR), and dosimetric plan quality, which was followed with an initial review by a dedicated steering committee. Candidate PR elements were then stratified by cases pertaining to treatment of locally-advanced (LA) disease with conventional RT, or stereotactic ablative body radiotherapy (SABR) for early-stage disease. A pan-Canadian, multidisciplinary Delphi panel was then assembled, and three Delphi rounds were undertaken (one pre-meeting survey, one face-to-face meeting, and one post-meeting ratification survey) to quantify participants’ rankings of the importance of each PR element, as well as the clarity of the wording for each. Finally, all endorsed elements were discussed for final wording by the steering committee.

Results: For LA cases, a total of six elements were considered as essential in the PR process. These included i) indications to treat with RT, ii) gross tumor volume (GTV), iii) clinical target volume (CTV), iv) internal target volume (ITV), v) dose/fractionation selection, and vi) normal lung dosimetry (ie V20, mean lung dose). Of these six elements, 90-100% of the panel in the final round endorsed these to be important to PR, and 80% felt that the PR should be done by a second radiation oncologist (RO). There were an additional three elements deemed optional for PR in these cases, including OAR contour review, PTV dosimetric coverage and maximum point dose, with review conditional dependent on the clinical scenario. In the cases of SABR, a total of six PR elements were deemed essential. These included i) indications to treat, ii) GTV, iii) CTV/ITV, iv) OAR contours, v) choice of dose/fractionation, and vi) review of composite plan for cases treated with previous RT. On the final round, 90-100% of panel members felt these elements to be important to PR, and unanimously agreed that PR should be done by a second RO. A further four elements were deemed optional based on the clinical scenario, including PTV dosimetric coverage, maximum point dose, OAR dosimetry, and best practices for daily image guidance.

Conclusion: A suite of elements for lung radiation PR has been developed and endorsed with high consensus across a multidisciplinary group of national experts in lung RT. These elements should serve as a basis to help streamline and create consistency among PR practices across centres, and to help develop novel PR approaches going forward.

Author Disclosure: A. Swaminath: None. L. Khan: None. C. Simniceanu: None. M.D. Brundage: Partner; Kingston General Hospital. Quality Leader, Radiation Oncology; Cancer Care Ontario.

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TU_28_3084 - Development of Best Practices of Peer Review in Lung Radiation Therapy

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