Prospective Peer Review for Hypo-Fractionated Treatments During the COVID-19 Pandemic

PURPOSE/OBJECTIVE(S): One of the measures taken in our department to minimize the risk of infection during the advent of the COVID-19 pandemic was to reduce the number of treatment fractions for appropriate disease sites. In this work we sought to assess peer-review grades for such hypofractionated cases during daily pre-dosimetric treatment planning multidisciplinary reviews as part of our ongoing quality control program. MATERIALS/METHODS: In our multi-center radiation medicine department, prospective video-conferenced reviews are conducted daily on all cases requiring a new treatment plan by a multidisciplinary team using an in-house electronic whiteboard linked with our oncology-information systems. Each case is allocated a grade of A, B or C on the treatment directive and contours to respectively proceed with, suggest minor revisions, or to require major revisions prior to dosimetric treatment planning. The database was queried for the years 2017 through 2021 to assess trends of grades assigned for hypofractionated plans for comparison with those for conventional and SBRT plans for the same anatomic sites, for both pre-COVID (2017-2019) and COVID (2020-2021) years. RESULTS: Of the 7179 plans generated during this period for 11 anatomic sites, 980 were hypofractionated, 4823 were conventionally fractionated, and 1376 were SBRT plans with overall grade breakdown as follows: A: 69.9%, B: 30.0%, C: 0.1%. The fraction of B grades for conventional, hypofractionated and SBRT cases respectively were: Bladder (51.4%, 34.3%, -), Bone (10.5%, 13.0%, 35.7%), Brain (29.3%, 28.1%, 30.2%), Breast (20.9%, 19.8%, 100.0%), Endometrium (45.6%, 0.0%, -), Lung (30.1%, 26.7%, 34.3%), Pancreas (44.0%, 16.7%, 41.6%), Pelvis (29.0%, 100.0%, -), Prostate (33.5%, 24.5%, 36.4%), Rectum (40.9%, 21.9%, -), Skin (34.9%, 33.3%, -). For most sites, hypofractionated cases had lower fractions of B-grades and higher fractions of A grades compared with conventional or SBRT cases. The differences overall were not statistically significant (Mann-Whitney non-parametric test, p-value>0.05). Differences in grade fractions were minor in COVID versus non-COVID years. The only statistically significant differences noted in time trends were between hypofractionated cases versus SBRT cases for the bone sites (p-value 0.04). CONCLUSION: Reducing the fractionation regimens for appropriate anatomic sites during the COVID-19 pandemic yielded no major differences in prospective peer-review assessments compared with conventional or SBRT assessments. Peer review enabled continued resilience during the pandemic ensuring continuity of the quality of care.