弥合沟通差距：一项前瞻性的单臂试验研究，测试了跨学科放射疗法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
影响因子:3.90000
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
摘要
通过放疗（RT）治疗局部晚期肺癌（LALC）可能具有挑战性。放射科医生和放射肿瘤学家（ROS）之间的多学科合作可以优化RT计划，减少后续成像解释的不确定性并改善结果。在RT计划完成之前，与放射科医生团队共享了具有初步辐照目标大纲的代表性计算机（CT）切片。主要终点是评估至少50％计划的RT模拟4个工作日期的可行性。三十七个肺癌患者被招募，并审查了37个RT计划中的35例。在审查的35名患者中，平均年龄为69岁。对于37个计划中的27个（73％），在4或更少的天数（3-4天）内收到反馈。在35例（37％）中，有13例收到了反馈，即划定的目标可能不包括所有对肿瘤参与的可疑地点。总共建议对35例（46％）中的16例过度或底层进行更改，以进行过度或秘密。放射学评论没有导致辐照体积的治疗延迟和实质性变化：总肿瘤体积，-1.9％至96.1％；计划目标量为-37.5％至116.5％。使用简化的工作流程的Interdoged InterdogedRocarinary RT计划是可行的，没有产生治疗延迟，并促使RT目标发生了实质性变化。
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.