Peer Review of Head and Neck Cancer Planning Target Volumes in Radiation Oncology

Abstract

<h3>Purpose/Objective(s)</h3> Radiation treatment plans undergo peer review during chart rounds, but changes to treatment volumes would require replanning. Our group implemented weekly head and neck cancer "volume rounds" to peer review all target volumes for head and neck cancer prior to radiation therapy (RT) planning and chart rounds. <h3>Materials/Methods</h3> We analyzed modifications made to planning target volumes (PTVs) at volume rounds for consecutive non-proton head and neck cancer cases from May 2020 to May 2021. Nine head and neck radiation oncologists participated in weekly volume rounds during this time. Recommendations were categorized as no changes, minor changes, major changes, additional workup (e.g., biopsy or imaging), and consultation or tumor board discussion needed prior to the start of RT. Minor changes to PTVs generally did not require a second review prior to treatment planning while major changes did. <h3>Results</h3> PTVs for 511 cases involving 432 patients underwent peer review and 298 (58.3%) of these cases did not require any modifications prior to treatment planning. Minor and major changes were recommended in 75 (14.7%) and 86 (16.8%) cases, respectively. Additionally, 45 (8.8%) cases were recommended to have further workup and 23 (4.5%) required further consultation with other non-radiation oncology services. Of the 45 cases that were recommended for further workup, 40 underwent biopsy or imaging. Positive findings on imaging or biopsy occurred in 13 patients leading to a significant change in management, including 4 patients that underwent further surgery after positive findings prior to the start of RT. <h3>Conclusion</h3> Prospective peer review during head and neck cancer volume rounds led to frequent minor and major alterations to PTVs. Significant changes in the overall treatment plan, such as additional surgery prior to start of RT, occurred in a minority of patients.