弥合沟通差距：一项前瞻性单臂试点研究评估跨学科放疗计划在局部晚期肺癌中的可行性

Bridging the Communication Gaps: A Prospective Single-Arm Pilot Study Testing the Feasibility of Interdisciplinary Radiotherapy Planning in Locally Advanced Lung Cancer

ACADEMIC RADIOLOGY

影响因子:3.9

分区:医学2区 / 核医学2区

发表日期:2023 Nov

作者: Michael K Farris, Niema B Razavian, Ryan T Hughes, James D Ververs, Anna C Snavely, Charles M Leyrer, Karen E Tye, Laura F Allen, Heather D Pacholke, Kathryn E Weaver, Paul M Bunch, Michael D Chan, Hollins Clark, Gregory Puthoff, Joshua C Farris, Cole R Steber, Stacy Wentworth, Beverly J Levine, Chandylen L Nightingale, Janardhana Ponnatapura

DOI: 10.1016/j.acra.2023.01.019

摘要

局部晚期肺癌（LALC）采用放疗（RT）治疗具有一定挑战性。放射科医师与放射肿瘤科医师（ROs）之间的多学科合作或能优化RT计划，减少随访影像解读的不确定性，并改善预后。在这项前瞻性临床试验（clinicaltrials.gov NCT04844736）中，纳入了37例接受根治性RT的LALC患者，来自4个治疗中心的6名ROs和3名胸部放射科医师被招募并纳入研究。在RT计划最终制定前，将代表性CT切片（带有初步照射目标轮廓）与放射科团队共享。主要评估指标是是否能在RT模拟后不超过4个工作日内获得反馈，且至少50%的方案达到此时限。共入组37例肺癌患者，35例RT方案被评审。被评审的患者平均年龄为69岁。在37个方案中，有73%的方案（27例）在4天或更少时间内获得反馈（四分位范围3-4天）。在35个案例中，有37%的方案（13例）反馈指出目标轮廓可能未涵盖所有疑似肿瘤部位。总体而言，在16例方案（46%）中建议对RT计划进行调整（覆盖不足或过度），且全部得到了落实。放射科评审未延误治疗，且对照射范围产生了显著影响：肿瘤体积变化从-1.9%到+96.1%；计划目标体积变化从-37.5%到+116.5%。采用简化流程的跨学科合作RT规划是可行的，未造成治疗延误，并促使RT目标发生重大调整。

Abstract

The treatment of locally advanced lung cancer (LALC) with radiotherapy (RT) can be challenging. Multidisciplinary collaboration between radiologists and radiation oncologists (ROs) may optimize RT planning, reduce uncertainty in follow-up imaging interpretation, and improve outcomes.In this prospective clinical treatment trial (clinicaltrials.gov NCT04844736), 37 patients receiving definitive RT for LALC, six attending ROs, and three thoracic radiologists were consented and enrolled across four treatment centers. Prior to RT plan finalization, representative computed tomography (CT) slices with overlaid outlines of preliminary irradiation targets were shared with the team of radiologists. The primary endpoint was to assess feasibility of receiving feedback no later than 4 business days of RT simulation on at least 50% of plans.Thirty-seven patients with lung cancer were enrolled, and 35 of 37 RT plans were reviewed. Of the 35 patients reviewed, mean age was 69 years. For 27 of 37 plans (73%), feedback was received within 4 or fewer days (interquartile range 3-4 days). Thirteen of 35 cases (37%) received feedback that the delineated target potentially did not include all sites suspicious for tumor involvement. In total, changes to the RT plan were recommended for over- or undercoverage in 16 of 35 cases (46%) and implemented in all cases. Radiology review resulted in no treatment delays and substantial changes to irradiated volumes: gross tumor volume, -1.9 to +96.1%; planning target volume, -37.5 to +116.5%.Interdisciplinary collaborative RT planning using a simplified workflow was feasible, produced no treatment delays, and prompted substantial changes in RT targets.