3211 - Quality Assurance in Head and Neck Radiation Therapy: A Prospective Analysis of Peer Review Recommendations in Disease-Site Specific Chart Rounds
Presenter(s)
F. Dayani1, M. Zhi2, B. Khodayari3, A. Bardwell2, H. Thomas4, J. F. Waxer2, R. C. Miller5, D. E. Go6, Z. A. Husain7, J. Han8, W. W. Lien3, J. Chen2, S. Iganej2, and O. Bhattasali2; 1Kaiser Permanente Los Angeles Medical Center, Department of Radiation Oncology, Los Angeles, CA, 2Southern California Permanente Medical Group, Los Angeles, CA, 3Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, 4University of California, San Francisco, San Francisco, CA, 5Department of Radiation Oncology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, 6Kaiser Permanente, Los Angeles Medical Center, Los Angeles, CA, 7Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada, 8Southern California Permanente Medical Group, Anaheim, CA
Purpose/Objective(s):
Head and neck (HN) radiation treatment (RT) planning requires a high level of complexity for accurate target and normal structure delineation to ensure optimal tumor coverage while minimizing toxicity. To enhance the rigor of plan evaluation, we implemented HN-specific chart rounds (HNCR) as a dedicated forum for in-depth peer review to enhance treatment quality and patient outcomes.Materials/Methods:
We prospectively collected data on all RT plans reviewed in HNCR from March 2024 to February 2025. Twelve HN radiation oncologists from a multi-center integrated healthcare system attended the conferences. Recommendations were classified into three categories: (1) major changes involving contour modification or dosimetric optimization of high-risk planning target volume (PTV) or critical organs at risk (OARs); (2) minor changes including contour modification or dosimetric optimization of intermediate/low-risk PTV or non-critical OARs, or patient setup modifications; or (3) plan of care changes such as obtaining additional diagnostic studies, consulting with other specialties, or altering treatment sequencing.Results:
A total of 344 radiation treatment plans were reviewed, including oropharyngeal (37%), oral cavity (15%), cutaneous (13%), salivary gland (9%), laryngeal (7%), nasopharyngeal (5%), unknown primary (5%), thyroid (2%), hypopharyngeal (2%), sinonasal (2%), and soft tissue (2%) malignancies and benign cases (1%). Of these, 56% of cases were treated in the definitive setting, and 44% were treated post-operatively. A total of 38 (11%) changes were recommended, comprised of 16 major changes, 21 minor changes, and 1 plan of care adjustment. Recommended major changes included modifications of target contours (n=13) and dosimetric optimization, which was performed for target volume coverage (n=1) and critical OARs (n=2). Minor changes included contour modifications for target volumes (n=18) and non-critical OAR (n=1), dosimetric optimization of non-critical OARs (n=1), and a change in patient setup (n=1). Contour modifications were more frequently recommended than dosimetric optimizations (10% vs. 1%, p<0.001). The subsites with the highest rates of plan modifications were nasopharynx (17%), salivary gland (16%), and oropharynx (15%). Rates of change were similar between definitive and adjuvant cases (12% vs. 9%, p=0.18). No significant relationship was found between physician experience level and the number of changes recommended (p=0.09).Conclusion:
HNCR enhanced RT quality by highlighting clinically relevant modifications for complex HN cases in a high-volume multi-center institution. HNCR was most valuable in identifying necessary modifications to target volume contours. Although no significant predictors of modification were identified, ongoing prospective assessment may further refine peer review processes and improve treatment quality.