Implementation of a dedicated head and neck radiotherapy peer review conference: results of a prospective study

Abstract

Background Head and neck radiotherapy (RT) is complex, involving multiple targets and organs at risk (OARs). Routine RT plan peer review is often inadequate for thorough review of the head and neck targets and OARs. Methods Patients treated between August 2020 and December 2021 were evaluated in a weekly structured head and neck RT plan peer review conference including at least one head and neck RT subspecialist. Patient and disease factors were recorded, as were the results of the peer review discussion, including the number and nature of recommended RT plan modifications and the rate of implementation. A major change was defined as any modification to the high-dose planning target volume (PTV) or RT prescription or fractionation. A minor change was defined as modification to at least one of the intermediate-dose PTV, low-dose PTV, or any OAR. Results 186 patients treated by 8 individual providers were prospectively recorded, 86.6% from the main site and 13.4% from 3 regional practices. The most common primary sites were oropharynx (29.6%), oral cavity (22%), cutaneous (16.7%), larynx/hypopharynx (16.1%). T3-4 disease was present in 68.3%, N2-3 in 37.6%. RT intent was definitive (44.6%), postoperative (49.5%), preoperative (1.6%), or palliative (4.3%). A major change was recommended in 14.5% (18 high-dose PTV, 7 prescription, 1 high-dose PTV and prescription) and implemented in 21 of 26 cases (80.8%). A minor change was recommended in 18.8% (20 low-dose PTV, 10 intermediate-dose PTV, 2 intermediate and low-dose PTV, 2 OAR, and 1 low-dose PTV and OAR) and implemented in 29 of 32 cases (90.6%). Additional workup was suggested in 2 cases (1.1%; 1 imaging study and 1 procedure) and was completed in both cases. Correction of plan changes was associated with a statistically significant delay of 1 day in overall treatment planning (p = 0.001). Discussion A dedicated peer review conference for head and neck RT plans is feasible and well-accepted by providers. Peer review with structured review of head and neck RT contour volumes is associated with substantial rates of suggested and implemented modifications to the plan with minimal treatment delay. Head and neck radiotherapy (RT) is complex, involving multiple targets and organs at risk (OARs). Routine RT plan peer review is often inadequate for thorough review of the head and neck targets and OARs. Patients treated between August 2020 and December 2021 were evaluated in a weekly structured head and neck RT plan peer review conference including at least one head and neck RT subspecialist. Patient and disease factors were recorded, as were the results of the peer review discussion, including the number and nature of recommended RT plan modifications and the rate of implementation. A major change was defined as any modification to the high-dose planning target volume (PTV) or RT prescription or fractionation. A minor change was defined as modification to at least one of the intermediate-dose PTV, low-dose PTV, or any OAR. 186 patients treated by 8 individual providers were prospectively recorded, 86.6% from the main site and 13.4% from 3 regional practices. The most common primary sites were oropharynx (29.6%), oral cavity (22%), cutaneous (16.7%), larynx/hypopharynx (16.1%). T3-4 disease was present in 68.3%, N2-3 in 37.6%. RT intent was definitive (44.6%), postoperative (49.5%), preoperative (1.6%), or palliative (4.3%). A major change was recommended in 14.5% (18 high-dose PTV, 7 prescription, 1 high-dose PTV and prescription) and implemented in 21 of 26 cases (80.8%). A minor change was recommended in 18.8% (20 low-dose PTV, 10 intermediate-dose PTV, 2 intermediate and low-dose PTV, 2 OAR, and 1 low-dose PTV and OAR) and implemented in 29 of 32 cases (90.6%). Additional workup was suggested in 2 cases (1.1%; 1 imaging study and 1 procedure) and was completed in both cases. Correction of plan changes was associated with a statistically significant delay of 1 day in overall treatment planning (p = 0.001). A dedicated peer review conference for head and neck RT plans is feasible and well-accepted by providers. Peer review with structured review of head and neck RT contour volumes is associated with substantial rates of suggested and implemented modifications to the plan with minimal treatment delay.