Peng Luke, Shin Kee-Young, Kosak Tara, Aizer Ayal A, Phillips John G, Pashtan Itai M
Department of Radiation Oncology, Dana-Farber Brigham Cancer Center, Boston, Massachusetts.
Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts.
Adv Radiat Oncol. 2025 Jul 31;10(10):101875. doi: 10.1016/j.adro.2025.101875. eCollection 2025 Oct.
Stereotactic radiation therapy (SRT) is highly effective but carries the risk of significant toxicity. We identified factors associated with SRT plans that require revision in a comprehensive, prospective peer review program conducted across a network of affiliated radiation oncology centers.
Weekly peer review rounds were conducted to review SRT cases prior to the start of radiation. Revision recommendations were tracked. Univariate and multivariable logistic regression was performed to identify factors associated with case revision.
From 2019 to 2024, 1172 SRT cases were reviewed at weekly rounds, including 313 brain stereotactic radiosurgery (SRS), 190 brain multi-fractionated SRS, and 669 stereotactic body radiation therapy. The yearly revision rate ranged from 19% in 2020 to 31% in 2024. There were 16 individual treating physicians with a median of 6 years of experience (range, 1-19 years), measured at the time of each SRT case review. Factors assessed for significance included SRT case volume in the 3 months preceding review (dichotomized as low- or high-volume), physician experience (≤2, 3-9, or ≥10 years), SRT technique (SRS, multi-fractionated SRS, or stereotactic body radiation therapy, and disease site. On multivariable logistic regression, revisions were less likely for high-volume physicians (odds ratio [OR], 0.58; 95% CI, 0.43-0.77), those with 3-9 years of experience (OR, 0.65; 95% CI, 0.44-0.96), and SRS technique (OR, 0.59; 95% CI, 0.41-0.84).
These data imply high value to prospective peer review for physicians with low SRT case volume and in their early career. Adequate case volume may be a critical factor for high quality SRT, analogous to the surgical literature. Annual revision rates in the program remained substantial over time, demonstrating the ongoing importance of an effective prospective peer review program for SRT.
立体定向放射治疗（SRT）疗效显著，但存在显著毒性风险。我们在一个附属放射肿瘤中心网络开展的全面、前瞻性同行评审项目中，确定了与需要修订的SRT计划相关的因素。
在放疗开始前，每周进行同行评审会议以审查SRT病例。跟踪修订建议。进行单变量和多变量逻辑回归分析，以确定与病例修订相关的因素。
2019年至2024年期间，每周共审查了1172例SRT病例，包括313例脑立体定向放射外科手术（SRS）、190例脑多分次SRS以及669例立体定向体部放射治疗。年度修订率从2020年的19%到2024年的31%不等。共有16位个体治疗医师，在每次SRT病例审查时，其经验中位数为6年（范围为1至19年）。评估显著性的因素包括审查前3个月内的SRT病例数量（分为低病例量或高病例量）、医师经验（≤2年、3至9年或≥10年）、SRT技术（SRS、多分次SRS或立体定向体部放射治疗）以及疾病部位。在多变量逻辑回归分析中，高病例量医师（优势比[OR]为0.58；95%置信区间[CI]为0.43 - 0.77）、经验为3至9年的医师（OR为0.65；95% CI为0.44 - 0.96）以及SRS技术（OR为0.59；95% CI为0.41 - 0.84）的病例修订可能性较小。
这些数据表明，对于SRT病例量低且处于职业生涯早期的医师而言，前瞻性同行评审具有很高的价值。与外科文献类似，充足的病例量可能是高质量SRT的关键因素。随着时间的推移，该项目中的年度修订率一直居高不下，这表明有效的SRT前瞻性同行评审项目具有持续的重要性。
