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AJNR Am J Neuroradiol. 2017 Jan;38(1):146-153. doi: 10.3174/ajnr.A4963. Epub 2016 Nov 3.

Impact of Neuroradiology-Based Peer Review on Head and Neck Radiotherapy Target Delineation.

Author information

1
From the Departments of Radiation Oncology (S.B., C.M.G., J.C., J.M.Q., S.S.Y.).
2
Radiology (C.M.G.), University of California, San Francisco, San Francisco, California.
3
From the Departments of Radiation Oncology (S.B., C.M.G., J.C., J.M.Q., S.S.Y.) yoms@radonc.ucsf.edu.

Abstract

BACKGROUND AND PURPOSE:

While standard guidelines assist in target delineation for head and neck radiation therapy planning, the complex anatomy, varying patterns of spread, unusual or advanced presentations, and high risk of treatment-related toxicities produce continuous interpretive challenges. In 2007, we instituted weekly treatment planning quality assurance rounds as a joint enterprise of head and neck radiation oncology and neuroradiology. Here we describe its impact on head and neck radiation therapy target delineation.

MATERIALS AND METHODS:

For 7 months, treatment planning quality assurance included 80 cases of definitive (48%) or postoperative (52%) head and neck radiation therapy. The planning CT and associated target volumes were reviewed in comparison with diagnostic imaging studies. Alterations were catalogued.

RESULTS:

Of the 80 cases, 44 (55%) were altered, and of these, 61% had clinically significant changes resulting in exclusion or inclusion of a distinct area or structure. Reasons for alteration included the following: gross or extant tumor, 26/44 (59%); elective or postoperative coverage, 25/44 (57%); lymph nodes, 13/44 (30%); bone, 7/44 (16%); skull base, 7/44 (16%); normal organs, 5/44 (11%); perineural, 3/44 (7%); distant metastasis, 2/44 (5%); and eye, 1/44 (2%). Gross tumor changes ranged from 0.5% to 133.64%, with a median change in volume of 5.95 mm3 (7.86%). Volumes were more likely to be increased (73%) than decreased (27%).

CONCLUSIONS:

A collaborative approach to head and neck treatment planning quality assurance has an impact. Cases likely to have challenging patterns of infiltrative, intracranial, nodal, orbital, or perineural spread warrant intensive imaging-based review in collaboration with a diagnostic neuroradiologist.

PMID:
27811130
DOI:
10.3174/ajnr.A4963
[Indexed for MEDLINE]
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