1. Targeted Intervention to Improve the Quality of Head and Neck Radiation Therapy Treatment Planning in the Netherlands: Short and Long-Term Impact.
- Author
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Verbakel WFAR, Doornaert PAH, Raaijmakers CPJ, Bos LJ, Essers M, van de Kamer JB, Dahele M, Terhaard CHJ, and Kaanders JHAM
- Subjects
- Benchmarking standards, Health Care Surveys, Humans, Netherlands, Organ Sparing Treatments standards, Organs at Risk diagnostic imaging, Parotid Gland diagnostic imaging, Parotid Gland radiation effects, Pharyngeal Muscles diagnostic imaging, Pharyngeal Muscles radiation effects, Quality Improvement, Radiation Dosage, Radiotherapy Planning, Computer-Assisted methods, Radiotherapy, Intensity-Modulated methods, Submandibular Gland diagnostic imaging, Submandibular Gland radiation effects, Time Factors, Tongue diagnostic imaging, Tongue radiation effects, Tonsillar Neoplasms diagnostic imaging, Tonsillar Neoplasms radiotherapy, Benchmarking methods, Head and Neck Neoplasms diagnostic imaging, Head and Neck Neoplasms radiotherapy, Organ Sparing Treatments methods, Organs at Risk radiation effects, Radiotherapy Planning, Computer-Assisted standards, Radiotherapy, Intensity-Modulated standards
- Abstract
Purpose: To benchmark and improve, through means of a targeted intervention, the quality of intensity modulated radiation therapy treatment planning for locally advanced head and neck cancer (HNC) in the Netherlands. The short and long-term impact of this intervention was assessed., Methods and Materials: A delineated computed tomography-scan of an oropharynx HNC case was sent to all 15 Dutch radiation therapy centers treating HNC. Aims for planning target volume and organ-at-risk (OAR) dosimetry were established by consensus. Each center generated a treatment plan. In a targeted intervention, OAR sparing of all plans was discussed, and centers with the best OAR sparing shared their planning strategies. Impact of the intervention was assessed by (1) short-term (half a year after intervention) replanning of the original case and (2) long-term (1 and 3 years after intervention) planning of new cases., Results: Benchmarking revealed substantial difference in OAR doses. Initial mean doses were 22 Gy (range, 15-31 Gy), 35 Gy (18-49 Gy), and 37 Gy (20-46 Gy) for the contralateral parotid gland, contralateral submandibular gland, and combined swallowing structures, respectively. Replanning after targeted intervention significantly reduced mean doses and variation, but clinically relevant differences still remained: 18 Gy (14-22 Gy), 28 Gy (17-45 Gy), and 29 Gy (18-39 Gy), respectively. One and 3 years later the variation remained stable., Conclusions: Despite many years of HNC intensity modulated radiation therapy experience, initial treatment plans showed surprisingly large variations. The simple targeted intervention used in this analysis improved OAR sparing, and its impact was durable; however, fairly large dose differences still continue to exist. Additional work is needed to understand these variations and to minimize them. A national radiation oncology platform can be instrumental for developing and maintaining high-quality planning protocols., (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Published
- 2019
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