Does Peer Review of Radiation Plans Affect Clinical Care? A Systematic Review of the Literature

Brunskill, Kelsey; Nguyen, Timothy; Boldt, Gabriel; Louie, Alexander V.; Warner, Andrew; Marks, Lawrence B.; Palma, David A.

doi:10.1016/j.ijrobp.2016.09.015

Cited by 68 publications

(57 citation statements)

References 27 publications

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“…This entails a nuanced decision-making process that encompasses both malignancy-related and patient-related factors, such as age, comorbidity, functional status, nutritional status, and psychosocial support structure. The presence of multidisciplinary tumor boards, 26 more robust peer review, 27 and greater access to clinical trials 28,29 also may influence outcomes at teaching hospitals in comparison with other centers. It is interesting to note that both institution type and institution volume previously have been observed to impact the choice of systemic therapy regimen.…”

Section: Discussionmentioning

confidence: 99%

“…[23][24][25] Teaching hospitals also may require physicians to stay abreast of the latest advances in head and neck cancer to train residents and fellow physicians. The presence of multidisciplinary tumor boards, 26 more robust peer review, 27 and greater access to clinical trials 28,29 also may influence outcomes at teaching hospitals in comparison with other centers.…”

Section: Discussionmentioning

confidence: 99%

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Treatment at high‐volume facilities and academic centers is independently associated with improved survival in patients with locally advanced head and neck cancer

David

Luu

et al. 2017

Cancer

127

125

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Treatment at high‐volume facilities and academic centers is independently associated with improved survival in patients with locally advanced head and neck cancer

David

Luu

et al. 2017

Cancer

127

125

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“… 42 , 43 Treatment at an HVF or AC may be more likely to involve peer review of treatment plans, which can lead to improvements in clinical care. 44 Taken together, the increased subspecialized care likely to be received at an HVF and/or AC may help account for these clinical benefits.…”

Section: Discussionmentioning

confidence: 99%

Treatment strategies and clinical outcomes of locally advanced pancreatic cancer patients treated at high-volume facilities and academic centers

David

Kim

Placencio-Hickok

et al. 2019

Advances in Radiation Oncology

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Purpose Locally advanced pancreatic cancer (LAPC) treatment has varying practice patterns with poor outcomes. We investigated treatment using single-agent chemotherapy and multiagent chemotherapy (MAC) with or without radiation therapy (RT) at high-volume facilities (HVFs) and academic centers (ACs). Methods and Materials The National Cancer Database was used to obtain data on 10,139 patients with LAPC. HVF was defined as the top 5% of facilities per number of patients treated at each facility. Univariate and multivariable (MVA) analysis Cox regressions were performed to identify the impact of HVF, AC, MAC, and RT on overall survival (OS). Results The median age of patients was 66 years (range, 22-90); 50.1% were male and 49.9% female. Of the patients, 46.1% received MAC, 53.8% received single-agent chemotherapy, 45.7% received RT, 54.3% did not receive RT, and 5% underwent surgical resection. The median follow-up was 48.8 months. On MVA, treatment at HVFs and ACs remained significantly associated with improved OS, with a hazard ratio (HR) of 0.84 ( P < .001) and 0.94 ( P = .004), respectively. The median OS for HVF treatment compared with low-volume facilities was 14.3 versus 11.2 months, respectively ( P < .001). The median OS for AC treatment versus non-AC was 12.1 versus 10.8 months, respectively ( P < .001). Additionally, on MVA, receipt of RT and MAC remained significantly associated with improved OS (HR: 0.76; P < .001; and HR: 0.73; P < .001, respectively). MVA for receipt of surgery showed that MAC is a significant predictor for receiving surgery (odds ratio: 1.29; P = .009). Conclusions Our results build on a growing literature supporting RT and MAC in treating LAPC. Additionally, we believe that—in the absence of prospective data—this makes a strong case for considering MAC with RT at ACs and HVFs for treating LAPC.

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“…This probably adversly affected the mrTRG grading. Although this was a single-centre study, the use of a detailed protocol, with an atlas [27] and the small group of clinicians involved who attend a weekly peer review meeting [28,29] are both factors that strengthen this series. The response assessment is also challenged by the three different groups in the series.…”

Section: Discussionmentioning

confidence: 99%

Intensity-Modulated Radiotherapy With a Simultaneous Integrated Boost in Rectal Cancer

et al. 2020

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Aims: Doseeresponse curves suggest that higher doses of radiotherapy improve the complete response rate in rectal cancer. The UK adopted the EXPERT trial dose and fractionation, 45 Gy in 25 fractions to the pelvis with a sequential 9 Gy in five fractions to the gross tumour, in patients where the aim was to maximise the complete response. In the Oxford University Hospital NHS Foundation Trust (Oxford, UK) we deliver a biological equivalent dose (BED5) in selected patients using intensity-modulated radiotherapy (IMRT) with a simultaneous integrated boost (SIB) in 25 fractions. We carried out a retrospective analysis of our series to: (i) document the toxicity of this protocol; (ii) ascertain whether dose constraints from RTOG 0822 were appropriate; (iii) assess the response. Materials and methods: The demographics and treatment details for all consecutive patients treated with this protocol were collected using electronic systems. Patients received 45 Gy to the elective nodes and 52 Gy using a SIB to the gross tumour with capecitabine chemotherapy using IMRT or RapidArc plans. Acute toxicity was collected prospectively during weekly reviews. For the purpose of this study, a dedicated gastrointestinal radiologist reviewed all baseline and posttreatment magnetic resonance images and assigned a magnetic resonance tumour regression grade (mrTRG). Results: Seventy-one patients were identified. Seventy completed radiotherapy with a median overall treatment time of 34 days (range 32e36 days); 67.6% received full-dose chemotherapy, with 21.2% receiving a reduced dose. There was a 4.2% incidence of grade 3þ non-haematological toxicity and 1.5% grade 3 þ haematological toxicity. 4.2% were admitted during their radiotherapy, with one death due to a pelvic abscess. The RTOG 0822 constraints were achieved in !75% of cases, other than the high-dose bladder constraint. mrTRG 1e2 was seen in 47.8%, with mrTRG 1 seen in 23.9%. Conclusions: We suggest that our protocol shows acceptable acute toxicity, with promising mrTRG results, and could be adopted by centres as an IMRT equivalent dose for EXPERT dose and fractionation.

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Does Peer Review of Radiation Plans Affect Clinical Care? A Systematic Review of the Literature

Cited by 68 publications

References 27 publications

Treatment at high‐volume facilities and academic centers is independently associated with improved survival in patients with locally advanced head and neck cancer

Treatment at high‐volume facilities and academic centers is independently associated with improved survival in patients with locally advanced head and neck cancer

Treatment strategies and clinical outcomes of locally advanced pancreatic cancer patients treated at high-volume facilities and academic centers

Intensity-Modulated Radiotherapy With a Simultaneous Integrated Boost in Rectal Cancer

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