Huo M, Gorayski P, Poulsen M, Thompson K, Pinkham M B
Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; The University of Queensland, St Lucia, Queensland, Australia.
The University of Queensland, St Lucia, Queensland, Australia; Radiation Oncology Centres Gold Coast, Gold Coast University Hospital, Southport, Queensland, Australia.
Clin Oncol (R Coll Radiol). 2017 Oct;29(10):680-688. doi: 10.1016/j.clon.2017.04.038. Epub 2017 May 18.
Technological advances in radiation therapy permit steep dose gradients from the target to spare normal tissue, but increase the risk of geographic miss. Suboptimal target delineation adversely affects clinical outcomes. Prospective peer review is a method for quality assurance of oncologists' radiotherapy plans. Published surveys suggest it is widely implemented. However, it may not be feasible to review every case before commencement of radiation therapy in all departments. The rate of plan changes following peer review of cases without a specific subsite or modality is typically around 10%. Stereotactic body radiation therapy, head and neck, gynaecological, gastrointestinal, haematological and lung cases are associated with higher rates of change of around 25%. These cases could thus be prioritised for peer review. Other factors may limit peer review efficacy including organisational culture, time constraints and the physical environment in which sessions are held. Recommendations for peer review endorsed by the American Society for Radiation Oncology were made available in 2013, but a number of relevant studies have been published since. Here we review and update the literature, and provide an updated suggestion for the implementation of peer review to serve as an adjunct to published guidelines. This may help practitioners evaluate their current processes and maximise the utility and effectiveness of peer review sessions.
放射治疗技术的进步使得从靶区到正常组织的剂量梯度很大，从而减少了正常组织受照剂量，但同时增加了靶区遗漏的风险。靶区勾画欠佳会对临床结果产生不利影响。前瞻性同行评审是一种确保肿瘤放疗医生治疗计划质量的方法。已发表的调查显示该方法已得到广泛应用。然而，在所有科室于放疗开始前对每个病例进行评审可能并不可行。对无特定亚部位或治疗方式的病例进行同行评审后，计划变更率通常约为10%。立体定向体部放疗、头颈部、妇科、胃肠道、血液科及肺部病例的计划变更率较高，约为25%。因此，这些病例可优先进行同行评审。其他因素可能会限制同行评审的效果，包括组织文化、时间限制以及开展评审会议的物理环境。美国放射肿瘤学会认可的同行评审建议于2013年发布，但自那时以来已有多项相关研究发表。在此，我们对文献进行回顾和更新，并为同行评审的实施提供最新建议，以作为已发表指南的补充。这可能有助于从业者评估其当前流程，并使同行评审会议的效用和有效性最大化。
