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The importance of standardized treatment planning and decision-making in radiation oncology for non-small-cell lung cancer—are current guidelines sufficiently strict for uniform target delineation?—a narrative literature review

par Descamps, Thomas ;Moretti, Luigi
Référence Precision cancer medicine, 5, 38
Publication Publié, 2022-12-01

Article révisé par les pairs

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Résumé :

Background and Objective: Quality of treatment planning and delivery in radiation oncology is crucial. To tackle inter-operator variability (IOV), peer review quality assurance (PRQA) has been increasingly implemented over the past decades and has become part of standard clinical practice, through recommendations in multiple national and regional guidelines. In the context of the ongoing peer review ProCaLung (PROject on the CAncer of the LUNG) initiative in Belgium, an assessment of current peer review practice in radiation oncology is proposed here. The main aims are to identify the frequency of changes, which aspects of treatment planning they occur in and what clinical impact good PRQA has. Additionally, current target delineation guidelines are reviewed to evaluate their suitability for standardized nodal volume peer reviewing in locally advanced non-small-cell lung cancer (NSCLC). Methods: A review of the published English literature was performed using the PubMed and Google Scholar databases within a specified timeframe (January 1, 2010–March 15, 2022). Publications must report the impact of peer review of one or multiple aspects of radiation oncology treatment planning. Current guidelines on peer review practice and treatment planning were obtained from the websites of respective societies. Key Content and Findings: Rates of changes recommended during peer review vary between 3.3% and 26%, with major changes occurring in 0.7% to 8.6% of cases. Changes occur across all elements of treatment planning, but those in target volume delineation (TVD) are most prevalent. No direct evidence proves the enhancement of clinical outcomes after peer review in routine practice. However, good quality control leads to better clinical outcomes in clinical trials, which could indicate that peer review is beneficial. The ESTRO-ACROP (The European Society for Radiation Oncology, The Advisory Committee for Radiation Oncology Practice) guidelines on target volume definition and delineation for locally advanced NSCLC are the most recent and comprehensive guidelines currently available, but they allow for a large variability in nodal TVD. This should be avoided when performing a standardized peer review of these volumes. Conclusions: PRQA in radiation oncology leads to frequent changes which have clinical impact. This supports the concept of a national peer review project aiming to standardize nodal treatment in NSCLC. However, current target delineation guidelines require adaptation before use in standardised peer review.