Managing motion in conventionally fractionated lung cancer radiation therapy: Collaborative quality improvement from a statewide consortium of academic and community practices

Abstract

The Michigan Radiation Oncology Quality Consortium (MROQC), funded by Blue Cross and Blue Shield of Michigan and Blue Care Network, was founded in 2011 as a collaborative effort between academic and community practice radiation oncology centers in the state of Michigan to assess the utilization of and need for advanced planning and delivery techniques in the treatment of breast and lung cancer patients. The consortium currently includes 22 active institutions. As part of the group’s efforts, several quality improvement projects have been initiated, such as the promotion of accelerated whole breast fractionation in eligible patients. 1 Jagsi R. Griffith K.A. Heimburger D. Walker E.M. Grills I.S. Boike T. et al. Choosing wisely? Patterns and correlates of the use of hypofractionated whole-breast radiation therapy in the state of Michigan. Int J Radiat Oncol Biol Phys. 2014; 90: 1010-1016 Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar In late 2014, a project was initiated to increase utilization of respiratory motion assessment for definitive, conventionally fractionated patients with lung cancer. Although national recommendations suggest motion assessment for patients in whom respiratory motion is expected to have a potential effect on treatment, 2 ASTRO A ACR–ASTRO practice parameter for image-guided radiation therapy (IGRT). 2014 Google Scholar , 3 Keall PJ Mageras GS Balter JM et al. The management of respiratory motion in radiation oncology report of AAPM Task Group 76. Med Phys. 2006; 33: 3874-3900 Crossref PubMed Scopus (1657) Google Scholar our data showed a consortium utilization rate of only 56%, with some institutions much lower than that. It can be difficult to predict which tumors may benefit from motion management techniques during treatment planning and/or delivery, 3 Keall PJ Mageras GS Balter JM et al. The management of respiratory motion in radiation oncology report of AAPM Task Group 76. Med Phys. 2006; 33: 3874-3900 Crossref PubMed Scopus (1657) Google Scholar , 4 Liu HH Balter P Tutt T et al. Assessing respiration-induced tumor motion and internal target volume using four-dimensional computed tomography for radiotherapy of lung cancer. Int J Radiat Oncol Biol Phys. 2007; 68: 531-540 Abstract Full Text Full Text PDF PubMed Scopus (275) Google Scholar , 5 Seppenwoolde Y Shirato H Kitamura K et al. Precise and real-time measurement of 3D tumor motion in lung due to breathing and heartbeat, measured during radiotherapy. Int J Radiat Oncol Biol Phys. 2002; 53: 822-834 Abstract Full Text Full Text PDF PubMed Scopus (1149) Google Scholar although the extent of motion, on average, is increased in nonattached and lower lobe tumors.