Diana Lin1, Kaitlyn Lapen1, Michael V Sherer2, Jolie Kantor1, Zhigang Zhang3, Lindsay M Boyce4, Walter Bosch5, Deborah Korenstein6, Erin F Gillespie7. 1. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York. 2. Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California. 3. Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York. 4. Memorial Sloan Kettering Library, Memorial Sloan Kettering Cancer Center, New York, New York. 5. Department of Radiation Oncology, Washington University in St Louis, St Louis, Missouri. 6. Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, New York. 7. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York; Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: gillespe@mskcc.org.
Abstract
PURPOSE: Clinical trials have described variation in radiation therapy plan quality, of which contour delineation is a key component, and linked this to inferior patient outcomes. In response, consensus guidelines have been developed to standardize contour delineation. This investigation assesses trends in contouring guidelines and examines the methodologies used to generate and deliver recommendations. METHODS AND MATERIALS: We conducted a literature search for contouring guidelines published after 1995. Of 11,124 citations, 332 were identified for full-text review to determine inclusion. We abstracted articles for the intent of the consensus process, key elements of the methodology, and mode of information delivery. A Fisher exact test was used to identify elements that differed among the guidelines generated for clinical trials and routine care. RESULTS: Overall, 142 guidelines were included, of which 16 (11%) were developed for a clinical trial. There was an increase in guideline publication over time (0 from 1995-1999 vs 65 from 2015- 2019; P = .03), particularly among recommendations for stereotactic radiation and brachytherapy. The most common disease sites were head and neck (24%), gastrointestinal (12%), and gynecologic (12%). Methods used to develop recommendations included literature review (50%) and image-based methods (45%). Panels included a median of 10 physicians (interquartile range, 7-16); 70% of panels represented multidisciplinary expertise. Guidelines developed for a clinical trial were more likely to include an image-based approach, with quantitative analysis of contours submitted by the panel members and to publish a full set of image-based recommendations (P < .005). CONCLUSIONS: This review highlights an increase in consensus contouring recommendations over time. Guidelines focus on disease sites, such as head and neck, with evidence supporting a correlation between treatment planning and patient outcomes, although variation exists in the approach to the consensus process. Elements that may improve guideline acceptance (ie, image-based consensus contour analysis) and usability (ie, inclusion of a full image set) are more common in guidelines developed for clinical trials. Published by Elsevier Inc.
PURPOSE: Clinical trials have described variation in radiation therapy plan quality, of which contour delineation is a key component, and linked this to inferior patient outcomes. In response, consensus guidelines have been developed to standardize contour delineation. This investigation assesses trends in contouring guidelines and examines the methodologies used to generate and deliver recommendations. METHODS AND MATERIALS: We conducted a literature search for contouring guidelines published after 1995. Of 11,124 citations, 332 were identified for full-text review to determine inclusion. We abstracted articles for the intent of the consensus process, key elements of the methodology, and mode of information delivery. A Fisher exact test was used to identify elements that differed among the guidelines generated for clinical trials and routine care. RESULTS: Overall, 142 guidelines were included, of which 16 (11%) were developed for a clinical trial. There was an increase in guideline publication over time (0 from 1995-1999 vs 65 from 2015- 2019; P = .03), particularly among recommendations for stereotactic radiation and brachytherapy. The most common disease sites were head and neck (24%), gastrointestinal (12%), and gynecologic (12%). Methods used to develop recommendations included literature review (50%) and image-based methods (45%). Panels included a median of 10 physicians (interquartile range, 7-16); 70% of panels represented multidisciplinary expertise. Guidelines developed for a clinical trial were more likely to include an image-based approach, with quantitative analysis of contours submitted by the panel members and to publish a full set of image-based recommendations (P < .005). CONCLUSIONS: This review highlights an increase in consensus contouring recommendations over time. Guidelines focus on disease sites, such as head and neck, with evidence supporting a correlation between treatment planning and patient outcomes, although variation exists in the approach to the consensus process. Elements that may improve guideline acceptance (ie, image-based consensus contour analysis) and usability (ie, inclusion of a full image set) are more common in guidelines developed for clinical trials. Published by Elsevier Inc.
Authors: Michael V Sherer; Diana Lin; Sharif Elguindi; Simon Duke; Li-Tee Tan; Jon Cacicedo; Max Dahele; Erin F Gillespie Journal: Radiother Oncol Date: 2021-05-11 Impact factor: 6.901
Authors: Helen Zhang; Ifeanyirochukwu Onochie; Lara Hilal; N Ari Wijetunga; Elizabeth Hipp; David M Guttmann; Oren Cahlon; Charles Washington; Daniel R Gomez; Erin F Gillespie Journal: Adv Radiat Oncol Date: 2022-07-29