Cleveland Clinic Taussig Cancer Center Cleveland, OH, United States
L. M. Keller1, M. A. Weller2, T. R. Meier1, S. T. Chao3, J. H. Suh3, and A. D. Vassil1; 1Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, 2Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, 3Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH
Purpose/Objective(s): Prospective Plan of Care (“Peer”) Review (PPCR) has been shown to catch major issues such as changes to target volumes, organs-at-risk (OAR) contours, the prescription, and overall treatment appropriateness (PMID: 36706911). Typically, when PPCR is employed, radiotherapy planning is held until the review is complete which can result in lengthened time-to-treatment (TTT). In effort to minimize the TTT for those undergoing PPCR we developed a PPCR process that does not hold treatment planning unless a major change is identified. We review our overall PPCR experience of over 5 years. Materials/
Methods: A weekly online departmental PPCR meeting was developed whereby a selection of definitive cases were chosen at random or submitted for review from across our Department of Radiation Oncology comprised of 32 physicians across various locations. Head and neck (H&N), stereotactic body radiation therapy (SBRT), and brachytherapy (brachy) PPCR became separate online meetings over time due to the level of expertise needed. An offline (independent) PPCR review option was also developed to reduce meeting time constraints. Results: From 7/2018 to 12/2023, 1670 definitive cases across a wide variety of diagnoses were prospectively reviewed at our weekly meeting. In addition to general appropriateness of treatment, cases were evaluated with respect to simulation, target volumes, OAR, and prescription (dose and fractionation). Consensus outcomes were recorded as either “agreed”, “minor suggestion” or “major suggestion” for each evaluation. When accounting for the cases reviewed through all of our prospective PPCR processes (i.e. offline, H&N, SBRT, brachy PPCR) 2813 total cases were reviewed in 2023 alone, representing 30% of our departmental cases. Table 1 shows the rate of minor and major changes recorded during our weekly PPCR meeting. When looking specifically at offline PPCR, we note a 17% “major” change for targets and 6% “major” change for prescription. In 2023 TTT (the interval from simulation to chart check) for all IMRT and SBRT cases through our department was 7.2 and 8.2 business days, respectively. Conclusion: PPCR continues to evolve at our institution. Offline PPCR may lead to an increased rate of “major” change outcomes perhaps due to its one-on-one nature (no group consensus) or perhaps these cases are inherently challenging or complex prompting colleagues to seek peer review before proceeding with treatment. We feel it valuable to continue weekly online and offline PPCR and are also in the process of creating disease specific PPCR or “office hours” in efforts to continue to have group consensus and solidify practice patterns within our department. Parallel PPCR is feasible, allowing for case review in 30% or more without a detrimental impact on departmental TTT metrics.
