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Gerard M Walls



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    P1.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 949)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.17-12 - Colleague Peer Review of Radical Lung Radiotherapy Treatment Plans: The Impact on Interval from Decision to Treat to Treatment Delivery (ID 13027)

      16:45 - 18:00  |  Presenting Author(s): Gerard M Walls

      • Abstract
      • Slides

      Background

      Quality assurance by colleague-led peer review (CPR) is recommended in the radiotherapy treatment planning of curative intent treatments such as for lung cancer. Previous studies have demonstrated a proportion of radiotherapy plans are amended following CPR resulting in enhanced quality and uniformity of treatment approached. CPR is an extra step in the radiotherapy planning process, and it may affect the timeliness of commencing radiotherapy. CPR was initiated in our centre in 2011. This study considers the temporal impact of adding an additional step to the planning process.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Using our institutional lung radiotherapy database we recorded the timescales between decision to treat (DTT) and commencement of radical lung radiotherapy, pre-peer review and post-peer review initiation at a single institution. The data for all patients was analysed for the years 2007 to 2017.

      4c3880bb027f159e801041b1021e88e8 Result

      Prior to peer review for the calendar year of 2007, 71% of the 63 patients receiving curative intent radiotherapy for lung cancer commenced treatment within 28 days of the DTT (median 26 days, range 0-61). In 2016, 80% of the 133 patients receiving curative intent radiotherapy had treatment initiated within 28 days (median 25 days, range 6-41). There was a notable reduction in the variability in planning time making booking of appointments with a reduction in extreme wait times to start treatment (figure 1).

      Figure 1 Box and whisker plot of the time from the decision to treat until the commencement of radiotherapy for the representative years available for analysis.

      time from dtt to tx.png

      8eea62084ca7e541d918e823422bd82e Conclusion

      In our institutional series, CPR does not prolong planning time with the median number of days taken to commence treatment remaining comparable, but may standardise radiotherapy start times due to enhanced team working via the CPR meetings. We recommend that peer review is performed as standard practice as it improves treatment quality without a detrimental prolongation of planning time.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 982)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.16-18 - Modern Radiotherapy Increases Patient Access to Curative Intent Radiotherapy in Non-Small Cell Lung Cancer (ID 13871)

      12:00 - 13:30  |  Author(s): Gerard M Walls

      • Abstract
      • Slides

      Background

      Technical developments in the delivery of radiotherapy such as image-guided radiotherapy (IGRT) and intensity modulated radiotherapy (IMRT) have permitted the introduction of advanced radiation techniques such stereotactic ablative radiotherapy (SABR). These new techniques have the advantage of more accurate localisation of the tumour and reduced irradiation of normal tissues. In our centre, we have implemented a range of new techniques to deliver IGRT (such as PET/CT and 4-dimensional CT planning, and cone beam CT during treatment delivery). We postulate that using the advanced techniques increases the access to curative intent radiotherapy treatment of lung cancer. We seek to assess the access rates to curative intent thoracic radiotherapy.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Using our institutional lung radiotherapy database we analysed the data recording intent of treatment with reference to the stage and performance status (PS) of all patients with stage 1-3 non-small cell lung cancer (NSCLC) in 2007 and compared this to the same population receiving radiotherapy during 2017 and up to April 2018.

      4c3880bb027f159e801041b1021e88e8 Result

      In 2007, 217 patients with stages 1-3 NSCLC received any radiotherapy compared to 218 patients for the 2017/2018 cohort. Within the 2017/2018 cohort 96% of patients (n=94) received radical radiotherapy compared to 28% of patients in 2007 (n=26). Of the 94 patients receiving radical treatment in 2017/2018, 61% received SABR. This increase was largely due to in the introduction of SABR. In those patients with stage 3 disease, overall fewer patients received any radiotherapy in 2017/2018 compared to 2007, however the number of patients receiving curative intent radiotherapy increased from 20 (13% of all stage 3 patients) to 44 (37%). Of note in those patients receiving curative intent radiotherapy there was an increase in access for patients with poorer PS, with only 7% of patients with a PS ≥2 in 2007 receiving curative intent radiotherapy compared with 42% of patients in 2017/2018.

      8eea62084ca7e541d918e823422bd82e Conclusion

      In our series, we report an increase in the proportion of patients with NSCLC receiving curative intent radiotherapy. Furthermore, more patients with a poorer performance status received curative intent radiotherapy. We suggest that the introduction of advanced radiotherapy techniques has permitted the curative intent treatment of patients who were previously treated with a palliative approach to management.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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