Multidisciplinary Imaging Review Conference Improves Neuro-oncology Radiation Treatment Planning and Follow-up

Rao, Dinesh; Fiester, Peter; Patel, Jeet; Rutenberg, M.S.; Holtzman, Adam L.; Dagan, Roi; Rotondo, Ronny L.; Sandhu, Sukhwinder J.S.

doi:10.7759/cureus.5882

Cited by 4 publications

(6 citation statements)

References 14 publications

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“…This again highlights the need to conduct these conferences and to have subspecialty musculoskeletal radiology re-review imaging studies. Our results are similar to those of past studies in other disciplines [6, 8, 13, 20, 24, 31]. In a study on a neuro-oncologic multidisciplinary conference, 47% of patients with neuro-oncologic imaging had a change in imaging interpretation that included major and minor changes, with most of the changes based on outside imaging.…”

Section: Discussionsupporting

confidence: 89%

What is the Value of Radiology Input During a Multidisciplinary Orthopaedic Oncology Conference?

Komarraju

Rilland

Gebhardt

et al. 2023

Clin Orthop Relat Res

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Background Multidisciplinary orthopaedic oncology conferences are important in developing the treatment plan for patients with suspected orthopaedic bone and soft tissue tumors, involving physicians from several services. Past studies have shown the clinical value of these conferences; however, the impact of radiology input on the management plan and time cost for radiology to staff these conferences has not been fully studied. Questions/purposes (1) Does radiology input at multidisciplinary conference help guide clinical management and improve clinician confidence? (2) What is the time cost of radiology input for a multidisciplinary conference? Methods This prospective study was conducted from October 2020 to March 2022 at a tertiary academic center with a sarcoma center. A single data questionnaire for each patient was sent to one of three treating orthopaedic oncologists with 41, 19, and 5 years of experience after radiology discussion at a weekly multidisciplinary conference. A data questionnaire was completed by the treating orthopaedic oncologist for 48% (322 of 672) of patients, which refers to the proportion of those three oncologists’ patients for which survey data were captured. A musculoskeletal radiology fellow and musculoskeletal fellowship–trained radiology attending physician provided radiology input at each multidisciplinary conference. The clinical plan (leave alone, follow-up imaging, follow-up clinically, recommend different imaging test, core needle biopsy, surgical excision or biopsy or fixation, or other) and change in clinical confidence before and after radiology input were documented. A second weekly data questionnaire was sent to the radiology fellow to estimate the time cost of radiology input for the multidisciplinary conference. Results In 29% (93 of 322) of patients, there was a change in the clinical plan after radiology input. Biopsy was canceled in 30% (24 of 80) of patients for whom biopsy was initially planned, and surgical excision was canceled in 24% (17 of 72) of patients in whom surgical excision was initially planned. In 21% (68 of 322) of patients, there were unreported imaging findings that affected clinical management; 13% (43 of 322) of patients had a missed finding, and 8% (25 of 322) of patients had imaging findings that were interpreted incorrectly. For confidence in the final treatment plan, 78% (251 of 322) of patients had an increase in clinical confidence by their treating orthopaedic oncologist after the multidisciplinary conference. Radiology fellows and attendings spent a mean of 4.2 and 1.5 hours, respectively, reviewing and presenting at a multidisciplinary conference each week. The annual combined prorated time cost for the radiology attending and fellow was estimated at USD 24,310 based on national median salary data for attendings and internal salary data for fellows. Conclusion In a study taken at one tertiary-care oncology program, input from radiology attendings and fellows in the setting of a multidisciplinary conference helped to guide the final treatment plan, reduce procedures, and improve clinician confidence in the final treatment plan, at an annual time cost of USD 24,310. Clinical Relevance Multidisciplinary orthopaedic oncology conferences can lead to changes in management plans, and the time cost to the radiologists should be budgeted for by the radiology department or parent institution.

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Section: Discussionsupporting

confidence: 89%

What is the Value of Radiology Input During a Multidisciplinary Orthopaedic Oncology Conference?

Komarraju

Rilland

Gebhardt

et al. 2023

Clin Orthop Relat Res

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“…Although there are differences between locations, possibly attributable to the mix of cases, it is notable that the percentage of peer review changes is higher in the presence of a neuroradiologist, consistent with the published series from Jacksonville and San Francisco, USA. 6,7 It is worth noting that the definition of major and minor changes in the current series differs from the Birmingham cohort, where significant changes included those with a high risk of geographical miss or extensive unnecessary impact on critical OARs or normal tissues, and minor changes were those when the original would have been acceptable. 10 The criteria for major and minor changes in the current series was based on RCR guidance.…”

Section: Discussionmentioning

confidence: 95%

“…The Royal College of Radiologists (RCR) guidance (2017) recommends prospective contour peer review for quality assurance, stating that attendance of a radiologist “may be useful”. 5 Two prospective series of skull base, central nervous system and radically treated HNC patients with neuroradiologist review led to changes in 47 and 55% of plans, 6,7 with 32% classified as major and 14% minor. 6 Absolute volume change for gross tumour volume (GTV) was 14.88 mm 3 (19.75%) and clinical target volume (CTV) was 14.63 mm 3 (21.83%).…”

Section: Introductionmentioning

confidence: 99%

“…5 Two prospective series of skull base, central nervous system and radically treated HNC patients with neuroradiologist review led to changes in 47 and 55% of plans, 6,7 with 32% classified as major and 14% minor. 6 Absolute volume change for gross tumour volume (GTV) was 14.88 mm 3 (19.75%) and clinical target volume (CTV) was 14.63 mm 3 (21.83%). 7 Small changes to target volumes were sometimes highly clinically significant, e.g.…”

Section: Introductionmentioning

confidence: 99%

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The impact of neuroradiology collaboration in head and neck cancer radiotherapy peer review

Gatfield

Benson

Jadon

et al. 2023

BJR

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Objectives: To quantify the impact of neuroradiologist presence on head and neck cancer (HNC) radiotherapy peer review (PR) changes. Methods: Prospective data was collected from HNC radiotherapy PR meetings; major, minor, and organ at risk (OAR) changes recorded. Differences in changes made with a neuroradiologist present were determined. Chi-squared tests of statistical significance were performed. Multivariate logistic regression identified potential predictors of changes. Results: Prospective PR was performed in 125/160 (78%) patients undergoing radical (chemo)radiotherapy for HNC between October 2018 and September 2019. Full PR documentation was available for 120/160 meetings (75%), with a neuroradiologist present in 53/120 (44%). Overall, 51/120 (42.5%) had changes made to target volumes or OARs. When a neuroradiologist was present, 29/53 (55%) of plans had changes made, compared to 22/67 (33%) in their absence. On multivariate analysis, neuroradiologist presence significantly influenced any changes made during the PR meetings (OR 2.59; 95% CI 1.05–6.43; p = 0.039). Conclusions: Neuroradiologist presence at PR meetings significantly influences changes made to HNC contouring, likely improving consistency and enhancing quality assurance. Advances in knowledge: This is the first published UK series demonstrating that a collaborative approach between radiology and oncology in PR meetings is significant in leading to contour changes for HNC.

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“…We recommended that participants be followed every 3 months for the first 2 years, every 6 months up to 5 years, then annually, thereafter, with basic examination and imaging and annual audiology, ophthalmology, and endocrine testing when indicated based on patient-specific doses to the organs at risk (OARs). Neuroimaging was reviewed at a multidisciplinary conference for treatment planning and, when indicated, with radiographic follow-up [ 3 ].…”

Section: Methodsmentioning

confidence: 99%

Clinical Outcomes Following Dose-Escalated Proton Therapy for Skull-Base Chordoma

Holtzman

Rotondo

Rutenberg

et al. 2021

International Journal of Particle Therapy

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Purpose To evaluate the effectiveness of external-beam proton therapy (PT) on local control and survival in patients with skull-base chordoma. Materials and Methods We reviewed the medical records of patients with skull-base chordoma treated with definitive or adjuvant high-dose PT and updated their follow-up when feasible. We assessed overall survival, disease-specific survival, local control, and freedom from distant metastasis. Radiotherapy toxicities were scored using the Common Terminology Criteria for Adverse Events, version 4.0. Results A total 112 patients were analyzed, of whom 105 (94%) received PT and 7 (6%) received combined proton-photon therapy between 2007 and 2019. Eighty-seven patients (78%) underwent a subtotal resection, 22 (20%) a gross total resection, and 3 (3%) a biopsy alone. The median radiotherapy dose was 73.8 Gy radiobiologic equivalent (GyRBE; range, 69.6-74.4). Ninety patients (80%) had gross disease at radiotherapy and 7 (6%) were treated for locally recurrent disease following surgery. Median follow-up was 4.4 years (range, 0.4-12.6); for living patients, it was 4.6 years (range, 0.4-12.6), and for deceased patients, 4.1 years (range, 1.2-11.2). At 5 years after radiotherapy, the actuarial overall survival, disease-specific survival, local control, and freedom from distant metastasis rates were 78% (n = 87), 83% (n = 93), 74% (n = 83), and 99% (n = 111), respectively. The median time to local progression was 2.4 years (range, 0.8-7). Local control and disease-specific survival by resection status was 95% versus 70% (P = 0.28) and 100% versus 80% (P = 0.06) for gross total, versus subtotal, resection or biopsy alone, respectively. There were no serious acute toxicities (grade ≥ 3) related to radiotherapy. Conclusion High-dose PT alone or after surgical resection for skull-base chordoma reaffirms the favorable 5-year actuarial local control rate compared with conventional techniques with acceptable late-complication–free survival. Outcomes following gross total resection and adjuvant PT were excellent. Further follow-up of this cohort is necessary to better characterize long-term disease control and late toxicities.

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Multidisciplinary Imaging Review Conference Improves Neuro-oncology Radiation Treatment Planning and Follow-up

Cited by 4 publications

References 14 publications

What is the Value of Radiology Input During a Multidisciplinary Orthopaedic Oncology Conference?

What is the Value of Radiology Input During a Multidisciplinary Orthopaedic Oncology Conference?

The impact of neuroradiology collaboration in head and neck cancer radiotherapy peer review

Clinical Outcomes Following Dose-Escalated Proton Therapy for Skull-Base Chordoma

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