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Peer review (PR) is a critical component of radiation oncology practice, but the methods by which this is carried out are highly variable. There has been a substantial change in the format and structure of inter- and intra-disciplinary meetings with the recent rise in virtual/hybrid teleconferencing. We surveyed NCI National Community Oncology Research Program (NCORP) sites to better understand the format, structure, and content of radiation oncology PR. A one-time survey was distributed to ROs across 42 NCORP community sites through the Wake Forest NCORP Research Base (UG1CA189824) between January and February 2024. The survey explored the routine PR practices of radiation oncologists. Twenty-eight radiation oncologists from 13 NCORP sites, all indicated that they participate in routine PR. Years of practice were 0-5 in 25%, 6-10 years in 36%, and >10 years in 39%. The frequency of PR meetings was weekly in 22 of 26, daily in 2, and every other week in 2. The participants were limited to radiation oncologists at all responding practices; no practices included interdisciplinary collaboration with radiologists in their PR. The format of PR was a hybrid of in-person/virtual at 13 practices, virtual only (no in-person/hybrid option) at 10, in-person only (no virtual/hybrid option) at 4, with 1 not reported. Six practices reported using some form of asynchronous PR (PR performed independently without the treating physician). The timing of PR was reported by 27 and included after treatment planning is complete (n = 19), after contouring but before plan creation/dose calculation (n = 2), and a mix of both (n = 6). For those reporting a mix of PR timing, the median percent of cases that underwent PR before dose calculation was 15% (range = 5-60) with the remaining 85% (range = 40-95) reviewed after plan completion. Components of the plans subject to PR (reported as the number reviewing each component, out of the 28 respondents) included contours (23), targets/organs at risk (25), dose distributions (26), dose-volume histograms (26), prescription dose/fractionation (27), diagnostic imaging (12), pathology data (13), and treatment intent (23). Other components reviewed included informed consent (1) and morbidity and mortality conference (1). Peer review in radiation oncology is a universal practice with more heterogeneity in the meeting format than is in the content reviewed. Most practices are performing PR after treatment planning is complete. Additional focus on the timing and format of radiotherapy plan PR is necessary to develop best practices to optimize safety and ensure comprehensive PR. [ABSTRACT FROM AUTHOR]

Stereotactic body radiation therapy (SBRT) for peripheral lung tumors can result in high radiation doses to surrounding ribs. Pre-clinical studies have shown single fraction doses of 2-10 Gy increase osteoclast activity and lead to bone loss. We conducted a randomized, double-blind, placebo-controlled trial to evaluate whether early suppression of osteoclast activity could mitigate SBRT-induced rib fractures. Between July 2019 and February 2022, 84 patients were enrolled. Eligible patients had lung tumors within 2 cm of chest wall and were randomized 1:1 to receive either a single dose of risedronate (150mg) or placebo delivered 7 to 21 days before SBRT (48-60 Gy in 3-10 fractions). Chest wall pain (CWP) was graded using modified CTCAE v5 assessed every 3 months after SBRT up to 1 year. Following a minimum period of one year post drug administration, a thoracic radiologist assessed all accessible imaging follow-up for fracture incidence. Seventy-six patients (38 placebo 38 risedronate) with 81 treated lung lesions were included in this analysis with a median follow-up of 26.3 months with a maximum of 43.4 months. Follow-up was measured from the end date of SBRT to the date of last available CT chest or date fracture detection. A total of 25 patients (33%) developed rib fractures. Median (range) values for rib (dose in EQD2, a/b = 3) and chest wall (3 cm thickness) structures are as follows: rib D0.03cc, 215 Gy (range = 52-373); rib D2cc, 101 (26-252); chest wall V30, 20 cc (0.5-314). There was no significant difference in fracture rates between risedronate and placebo groups - 13 risedronate group (34.2%) vs 12 in placebo arm (31.6%) (p = 0.2). Among those who fractured, the median time to fracture was 14.2 mo (95% CI = 9.8 - 16.9 mo) [range 5.9 - 43.4 mo] with 9 patients developing fracture within 1 year from the end of SBRT. Patients receiving risedronate had a significantly lower rate of grade 2+ CWP within 1 year post SBRT completion compared to patients who received placebo: 18% versus 42% respectively (P = 0.045), Among patients who did not develop a detectable fracture, the rate of G2+ CWP was (12 % vs 34.6% P = 0.06) favoring the risedronate arm, and similarly among those who did develop fractures, the incidence of G2+ CWP was 31% vs 58% (p = 0.17). For patients receiving SBRT for peripheral lung tumors, the use of prophylactic risedronate, when compared to placebo, did not reduce the incidence of treatment-induced rib fractures. The use of risedronate, however, lowered the risk of G2+ CWP. The suggested protective impact of risedronate against G2 or higher CWP may point to a nerve and osteoclast cross talk mechanism contributing to the development of SBRT-induced CWP. Alternatively, risedronate may have partially reduced osteoclast activity, preventing the accumulation of microfractures that could have contributed to pain. Further investigations into the appropriate dose and type of antiresorptive agent to specifically counteract bone loss and prevent pain or fracture after thoracic SBRT are warranted [ABSTRACT FROM AUTHOR]

Multidisciplinary collaboration in radiation oncology is important to optimizing patient cancer care in both the pre and post treatment setting. Despite interest in collaboration and potential benefits, many barriers prevent effective and efficient communication, particularly between radiation oncologists (ROs) and radiologists. A one-time survey was distributed to ROs across 42 NCORP regional network through the Wake Forest NCORP Research Base (UG1CA189824) hospitals between January and February 2024. The survey explored the frequency and nature of RO-radiologist collaboration during RT planning, peer review processes, perceived barriers to collaboration, discordance in post treatment imaging interpretation, and interest in interventions to improve multidisciplinary interactions. Among 28 radiation oncologists from 13 NCORP sites, 64% reported engaging with radiologists for feedback on contoured RT targets in the past year, yet no practices routinely included radiologists in standard pre-treatment chart rounds conferences. Significant barriers to collaboration were identified, including time constraints (43%), workflow disruptions (50%), challenges in sharing imaging comprehensively (61%), and difficulties in discussing target adjustments (39%). When asked "How often do you encounter discordant post treatment imaging interpretation between ROs and radiologists that requires discussion or amendments in the reported findings (the interpreting radiologist does not know that a region of interest was recently treated and interprets post treatment effect as progressive disease or vice versa), only one provider reported 0 cases, while 50% of respondents indicated discordance often (5-9 times per year) or very often (10 or more times per year). Three providers indicated this occurs greater than 30 times per year, while one provider indicated this occurs approximately 100 times per year. A notable 71% expressed high or very high interest in clinical trials aimed at improving collaboration between these two specialties. There is considerable interest among community ROs for improving current methods of multi-disciplinary collaboration with radiologists during the pre and post treatment setting. Strategies to address common communication barriers have the potential to dramatically enhance cancer care delivery for providers and patients. [ABSTRACT FROM AUTHOR]