How Often Do Radiation Plans Need Peer Review Changes?

TOPLINE:

Institutional peer review of radiation therapy resulted in changes to treatment plans in over a quarter of cancer cases, according to a meta-analysis that identified target volume delineation and target dose prescription as the primary areas requiring revision.

METHODOLOGY:

• Peer review of radiotherapy treatment plans can improve patient safety and treatment effectiveness, but the process often encounters implementation challenges due to resource constraints. Understanding the impact of radiotherapy peer review is crucial to encouraging adoption and optimizing the approach.
• To evaluate the effect of institutional peer review on radiotherapy treatment plans, researchers conducted a systematic review and meta-analysis of 55 studies, spanning data from January 2000 to May 2024 and 10 countries.
• Most of the studies (62%) were conducted in North America, followed by Europe (18%), Australia (9%), and Asia (7%).
• The analysis included 96,444 case audits, with a mean of 1754 cases audited per study. Most studies focused on multiple disease sites (58%), and others focused on individual cancer types, such as head and neck (14 of 55), lung (2 of 55), and breast (2 of 55).
• Researchers examined various factors influencing recommendation changes from peer review, including cancer type, treatment intent, radiotherapy technique, timing of peer review, and composition of peer review teams. The definition of a major change included treatment plans requiring replanning or resimulation and were often associated with plan rejection or safety concerns.

TAKEAWAY:

• The pooled proportion of any recommended change from peer review occurred in 28% of cases audited; major changes occurred in 12% of cases, though the range across studies varied considerably (from
• The most frequent reasons for revisions in the treatment plan were target delineation (45%), target dose prescription (33%), organ at risk dose prescription (9%), and organ at risk volume delineation (5%).
• Across all studies, the recommended changes were significantly different by cancer type. Treatment plans for head and neck, gastrointestinal, lung, and gynecologic cancers had a higher likelihood of recommendation changes compared with other disease sites. Similarly, studies suggested that the likelihood of a recommended change significantly differed by the composition of the peer review teams. The likelihood of recommended changes increased, for instance, when reviewed by neuroradiologists or treating radiation oncologists at peer review meetings and often decreased when more physicians were involved in the decision.
• Major change recommendations varied significantly by cancer type and the timing of peer review, with post hoc reviews yielding more changes than real-time reviews. However, researchers found no significant differences in the frequency of major changes by study location, treatment intent, radiotherapy techniques, and duration of peer review.

IN PRACTICE:

This analysis provides evidence that “peer-review results in treatment plan change recommendations in over one in four patients,” the authors wrote. “Of these change recommendations, nearly half were considered major, requiring replanning or resimulation due to safety concerns — emphasizing the importance of peer review for safe and effective radiotherapy.” Given the findings, the authors recommended “all cases should be considered for early peer review, regardless of radiotherapy intent or technique, to ensure consistent and safe radiotherapy practices.”

SOURCE:

The study, led by Jane Jomy, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada, was published online in Radiotherapy and Oncology.

LIMITATIONS:

The peer-review processes varied widely across studies in timing, composition, and rigor, which may have led to heterogeneous or inconsistent results. Additionally, the findings may have been affected by publication bias as studies reporting lower rates of recommendation changes were less likely to be published.

DISCLOSURES:

The authors did not declare any funding information. The authors reported no relevant conflicts of interest or financial relationships that could have influenced the study findings.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.