The Impact of Colleague Peer Review on the Radiotherapy Treatment Planning Process in the Radical Treatment of Lung Cancer

K P Rooney, J McAleese, C Crockett, J Harney, R L Eakin, V A L Young, M. A. Dunn, Ruth E Johnston, G G Hanna

Research output: Contribution to journalArticlepeer-review

25 Citations (Scopus)


AIMS: Modern radiotherapy uses techniques to reliably identify tumour and reduce target volume margins. However, this can potentially lead to an increased risk of geographic miss. One source of error is the accuracy of target volume delineation (TVD). Colleague peer review (CPR) of all curative-intent lung cancer plans has been mandatory in our institution since May 2013. At least two clinical oncologists review plans, checking treatment paradigm, TVD, prescription dose tumour and critical organ tolerances. We report the impact of CPR in our institution.

MATERIALS AND METHODS: Radiotherapy treatment plans of all patients receiving radical radiotherapy were presented at weekly CPR meetings after their target volumes were reviewed and signed off by the treating consultant. All cases and any resultant change to TVD (including organs at risk) or treatment intent were recorded in our prospective CPR database. The impact of CPR over a 13 month period from May 2013 to June 2014 is reported.

RESULTS: One hundred and twenty-two patients (63% non-small cell lung carcinoma, 17% small cell lung carcinoma and 20% 'clinical diagnosis') were analysed. On average, 3.2 cases were discussed per meeting (range 1-8). CPR resulted in a change in treatment paradigm in 3% (one patient proceeded to induction chemotherapy, two patients had high-dose palliative radiotherapy). Twenty-one (17%) had a change in TVD and one (1%) patient had a change in dose prescription. In total, 6% of patients had plan adjustment after review of dose volume histogram.

CONCLUSION: The introduction of CPR in our centre has resulted in a change in a component of the treatment plan for 27% of patients receiving curative-intent lung radiotherapy. We recommend CPR as a mandatory quality assurance step in the planning process of all radical lung plans.

Original languageEnglish
Pages (from-to)514-8
Number of pages5
JournalClinical Oncology
Issue number9
Early online date03 Jul 2015
Publication statusPublished - Sept 2015

Bibliographical note

Upon appointment as a Consultant and supported by my clinical colleagues, I established the 1st radiotherapy peer review meeting for any tumour type at the clinical cancer centre, the Lung Peer Review Meeting. We established a database to record and analyse decisions and outcomes from this meeting. From this we presented our findings at a number of international meetings and published the outcomes in this paper. This was novel as was the detail we included. Although the journal is only ranked 4th in the field of radiotherapy it is highly respected and the paper itself has been cited and reported in a combined analysis of subsequent findings. This paper has had significant clinical impact prompting visits from other leading UK radiotherapy centres to see and learn from our meeting as they implement their own Peer Review Meetings. The paper is thus practice changing.


  • lung cancer
  • Peer Review


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