前瞻性放疗质量保证导致复发性直肠癌划定指南的改进：来自PelvEx II研究的经验

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology Pub Date : 2025-02-13 DOI:10.1016/j.ctro.2025.100934

F. Piqeur , B.J.P. Hupkens , D.M.J. Creemers , S. Nordkamp , M. Berbee , J. Buijsen , H.J.T. Rutten , C.A.M. Marijnen , J.W.A. Burger , H.M.U. Peulen

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引用次数: 0

摘要

局部复发直肠癌（LRRC）的靶体积划定在临床上具有挑战性。为了确保PelvEx II试验中的放化疗（CRT）质量，制定了划定指南，并为所有患者建立了前瞻性质量保证（QA）。指南遵循，QA对目标卷的影响，以及随后的指南改进在本文中进行了描述。方法和材料所有PelvEx II患者，无论是首次放疗患者（50-50.4 Gy）还是再放疗患者（30 Gy），都有资格在CRT前进行QA。治疗前，每位患者计划与主治医生和质量保证团队进行一次在线会议，以进行同行评议。对7项（再照射）或8项（单纯放疗）指南建议的依从性进行评分。建议的目标音量调整和任何偏离协议的原因都被记录下来。在适用的情况下，对QA前后的目标体积进行比较。试用QA团队讨论了可能的协议改进。结果对113例LRRC进行前瞻性回顾，QA符合率高达90 %。53% %的病例遵循了所有指南建议。建议改变GTV和CTV分别为21例和39例。制造中心的值增加(+ 29 % (p & lt; 0.001))和CTV(+ 15 % (p & lt; 0.001))再照射患者发现,与平均CTV增加 + 6 % (p = 0.002)在RT天真的病人QA。30例（27 %）接受偏离方案。会议商定了13项协议的改进。结论LRRC靶体积的同行评议导致多达48%的病例靶体积发生改变，从而导致更新的描绘指南。

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Prospective radiotherapy quality Assurance leads to delineation guideline refinements for recurrent rectal cancer: Experience from the PelvEx II study

Introduction

Target volume delineation in locally recurrent rectal cancer (LRRC) is clinically challenging. To ensure the quality of chemoradiotherapy (CRT) within the PelvEx II trial, a delineation guideline was developed and prospective quality assurance (QA) was instated for all patients. Guideline adherence, the impact of QA on target volumes, and subsequent guideline refinements are described in this paper.

Methods and materials

All PelvEx II patients, either RT naive patients (50–50.4 Gy) or reirradiation (30 Gy) patients, were eligible for QA prior to CRT. An online meeting with the treating physician and the QA team was planned for each patient prior to treatment, to peer review delineations. Adherence to each of the 7 (reirradiation) or 8 (RT naive) guideline recommendations was scored. Suggested target volume adjustments and any reasons to deviate from protocol were noted. When applicable, target volumes before and after QA were compared. Possible protocol refinements were discussed amongst the trial QA team.

Results

Prospective review of 113 cases of LRRC was performed, resulting in a high QA compliance rate of 90 %. All guideline recommendations were followed in 53 % of cases. Changes to the GTV and CTV were advised in 21 and 39 cases respectively. A median increase of GTV (+29 % (p < 0.001)) and CTV (+15 % (p < 0.001)) was seen in reirradiation patients, versus a median CTV increase of + 6 % (p = 0.002) in RT naive patients following QA. Deviations from protocol were accepted in 30 cases (27 %). Thirteen protocol refinements were agreed upon.