Dose Planning and Radiation Optimization for Thoracic Conventional, Twice Daily, and Stereotactic Radiation Therapy: A Delphi Consensus From a National Survey of Practitioners.

Abstract

Purpose: We sent surveys to a large number of radiation oncologists with active thoracic cancer practices and applied the Delphi method over 3 rounds to generate consensus dose-volume histogram metrics. We used these results to create consensus-based organs-at-risk dose constraints and target goal templates for practical implementation.

Methods and materials: In this institutional review board-approved study, data were collected using REDCap electronic data capture on a secure server. Radiation oncologists identified from the Accreditation Council for Graduate Medical Education-accredited departments' websites were asked to confirm their self-identification as thoracic radiation oncologists and nominate other respondents. All invitees were asked to complete 3 rounds of questions related to normal tissue constraints, target coverage metrics, prescribing practices, and other planning considerations. Preliminary consensus statements were presented in the second round of surveys for voting on a 5-point Likert scale. The third and last round of surveys presented the iterated consensus statements and target coverage metric statements for final voting. The high consensus was predefined as ≥ 75% agreement.

Results: Eighty-three (42.8%) of 194 invitees completed at least 1 round of surveys. The group included a diversity of gender, geography, and clinical settings. Response rates were 83%, 57%, and 55%, respectively, for the 3 rounds. By the end of the process, 48 of 96 (50%) originally proposed normal tissue dose constraint statements were iterated to consensus, and 5 of 7 (71%) proposed target coverage metric statements achieved consensus. These were used to create crowdsourced treatment planning templates.

Conclusion: This study achieved broad-based consensus-building on ideal and acceptable dose constraints for conventional, twice-daily, and stereotactic thoracic radiation therapy. Future directions could include extending this approach to other disease sites, studying the influence of widespread implementation on treatment planning, or facilitating the development of community consensus around emergent or controversial questions.