Assessing the Value of Peer Review of Target Volume Contours Prior to Treatment Planning in Head and Neck Cancer

Summary: Head and neck (HN) cancer patients are commonly treated with photon or proton therapy. In our photon practice, there is a 7-10-day carepath from simulation to treatment start, and HN peer review is conducted once weekly over 1 hour. Our proton practice has a 10-day carepath, and HN peer review occurs three times weekly (MWF, ~2 hours total time), aiming to present each patient for preplanning target volume contour review (PPTVCR) and again when the treatment plan is prepared. We sought to compare the frequency of PPTVCR between the two cadences of peer review, to assess the impact of PPTVCR on the replanning rate, and to estimate the labor cost associated with replanning. This retrospective analysis evaluated HN cases peer reviewed from January 1 through March 1, 2024. Fisher’s exact test was used to compare differences between cohorts. Median salary data from the U.S. Bureau of Labor Statistics and MGMA were used to estimate labor costs associated with replanning using a median time of 5 hours for dosimetry, 2.5 hours for medical physics, 1 hour for the radiation oncologist, and 0.5 hour for radiation therapy. During the study period, there were 36 photon and 54 proton HN cases in peer review. Three times weekly peer review accomplished PPTVCR in 51/54 (94%) versus 16/36 (44%) in weekly peer review (P< 0.01). A log of recommendations from PPTVCR were only available for proton cases, with approximately 18% having recommended changes. Among the 67 total cases undergoing PPTVCR, in subsequent peer review of the treatment plan 1/67 (1%) required replanning, compared to 3/20 (15%) cases that did not have PPTVCR (P=0.037). The estimated labor cost was $833 per replan. At an annualized rate of 500 head and neck cases treated per year at our institution, if a strategy of once weekly peer review were used consistently, an estimated 280 (56%) patients may not undergo PPTVCR and 42 (15%) may require replanning yielding an estimated labor cost of $34,987 per year. The value of the extra hour spent each week peer review is estimated at $673 based on labor costs associated with replanning less the opportunity cost / value of labor devoted to peer review. PPTVCR led to an absolute 14% reduction in replanning. Conducting peer review three times weekly was associated with a significantly higher PPTVCR rate and a significantly lower replanning rate. The time spent in more frequent peer review is estimated to decrease labor costs associated with replanning, but must be weighed against the costs of the extra time spent on PPTVCR. Prospective peer review of HN target volumes prior to treatment planning could improve plan quality and reduce costs associated with replanning. Taylor J. Corriher, n/a (Presenting Author) - Emory University School of Medicine Department of Radiation Oncology; Beth Bradshaw Ghavidel, MS, DABR (Co-Author) - Winship Cancer Institute of Emory University; Mosa Pasha, CMD (Co-Author) - Emory Proton Therapy Center; Marian Axente, PhD, DABR (Co-Author) - Winship Cancer Institute of Emory University; Eric Elder, PhD, MS (Co-Author) - Winship Cancer Institute of Emory University; Meysam Tavakoli, PhD, MSc (Co-Author) - Winship Cancer Institute of Emory University; Eduard Schreibmann, PhD (Co-Author) - Winship Cancer Institute of Emory University; Oluwatosin Kayode, CMD (Co-Author) - Winship Cancer Institute of Emory University; James Bates, MD (Co-Author) - Winship Cancer Institute of Emory University; Jill Remick, MD (Co-Author) - Winship Cancer Institute of Emory University; Soumon Rudra, MD (Co-Author) - Winship Cancer Institute of Emory University; Sibo Tian, MD (Co-Author) - Winship Cancer Institute of Emory University; William A.. Stokes, MD (Co-Author) - Winship Cancer Institute of Emory University; Mark McDonald, MD (Co-Author) - Emory Proton Therapy Center