Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157.
Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157.
Acad Radiol. 2023 Nov;30(11):2566-2573. doi: 10.1016/j.acra.2023.01.019. Epub 2023 Feb 8.
The treatment of locally advanced lung cancer (LALC) with radiotherapy (RT) can be challenging. Multidisciplinary collaboration between radiologists and radiation oncologists (ROs) may optimize RT planning, reduce uncertainty in follow-up imaging interpretation, and improve outcomes.
In this prospective clinical treatment trial (clinicaltrials.gov NCT04844736), 37 patients receiving definitive RT for LALC, six attending ROs, and three thoracic radiologists were consented and enrolled across four treatment centers. Prior to RT plan finalization, representative computed tomography (CT) slices with overlaid outlines of preliminary irradiation targets were shared with the team of radiologists. The primary endpoint was to assess feasibility of receiving feedback no later than 4 business days of RT simulation on at least 50% of plans.
Thirty-seven patients with lung cancer were enrolled, and 35 of 37 RT plans were reviewed. Of the 35 patients reviewed, mean age was 69 years. For 27 of 37 plans (73%), feedback was received within 4 or fewer days (interquartile range 3-4 days). Thirteen of 35 cases (37%) received feedback that the delineated target potentially did not include all sites suspicious for tumor involvement. In total, changes to the RT plan were recommended for over- or undercoverage in 16 of 35 cases (46%) and implemented in all cases. Radiology review resulted in no treatment delays and substantial changes to irradiated volumes: gross tumor volume, -1.9 to +96.1%; planning target volume, -37.5 to +116.5%.
Interdisciplinary collaborative RT planning using a simplified workflow was feasible, produced no treatment delays, and prompted substantial changes in RT targets.
局部晚期肺癌（LALC）的放射治疗（RT）可能具有挑战性。放射科医生和放射肿瘤学家（RO）之间的多学科合作可以优化 RT 计划，减少随访影像学解释的不确定性，并改善结果。
在这项前瞻性临床治疗试验（clinicaltrials.gov NCT04844736）中，37 名接受 LALC 根治性 RT 的患者、6 名主治 RO 和 3 名胸部放射科医生在四个治疗中心同意并入组。在 RT 计划定稿之前，与放射科医生团队共享具有初步照射靶区叠加轮廓的代表性 CT 切片。主要终点是评估至少 50%的计划在 RT 模拟后 4 个工作日内收到反馈的可行性。
共纳入 37 例肺癌患者，其中 37 例 RT 计划中有 35 例进行了评估。在接受评估的 35 例患者中，平均年龄为 69 岁。在 37 个计划中的 27 个（73%）中，在 4 天或更短的时间内收到了反馈（四分位距 3-4 天）。在 35 例中有 13 例（37%）的反馈表明，划定的靶区可能没有包括所有可疑肿瘤受累的部位。总共，在 35 例中有 16 例（46%）建议对 RT 计划进行覆盖过多或不足的修改，并在所有病例中实施。放射学审查没有导致治疗延迟，并对照射体积产生了重大变化：大体肿瘤体积，-1.9 至+96.1%；计划靶体积，-37.5 至+116.5%。
使用简化工作流程的跨学科合作 RT 计划是可行的，不会导致治疗延迟，并促使 RT 靶区发生重大变化。
