Quality Assurance Peer Review for Radiotherapy for Haematological Malignancies

Abstract

Aims: To assess the impact of weekly scheduled peer review of radiotherapy planning contours for definitive treatment of haematological malignancies based on rates of recommended changes.

Materials and methods: Analysis of a prospective database of contour-based peer review at weekly scheduled meetings for patients undergoing definitive radiotherapy for haematological malignancies at a single large cancer centre between January and December 2018. Recommended changes were prospectively classified as involving the gross tumour volume (GTV), clinical target volume (CTV), planning target volume (PTV), organs at risk or dose fractionation. A univariate analysis was carried out to explore the associations between recommended changes and disease, treatment characteristics and consultant experience.

Results: In total, 158/171 (92%) of all cases of haematological malignancy undergoing definitive radiotherapy were prospectively peer reviewed over a 12-month period. Overall, 26/158 (16.5%) changes were recommended within the peer review meetings. This included a total of 27 contour changes (GTV, CTV or PTV) in 25 patients. An increase in CTV was the most common change, occurring in 20/158 (12.7%) cases. One dose-fractionation change was recommended. Additional advice regarding planning technique/set-up was documented in 5/158 (3.2%) patients. There were no significant associations between rates of recommended change and disease type, stage, prior chemotherapy, first line versus refractory/relapse, anatomical site, radiotherapy technique or consultant experience.

Conclusions: Weekly contour-based peer review meetings resulted in a high rate of recommended changes. Compliance was high. Peer review was potentially beneficial for all disease and treatment characteristics and for any degree of clinician experience.

Keywords: Lymphoma; peer review; plasmacytoma; quality assurance; radiotherapy.