Case Volume and Experience in Stereotactic Radiation: Analysis of a Prospective Peer Review Program

Area of Science:

• Radiation Oncology
• Medical Physics
• Clinical Research

Background:

• Stereotactic radiation therapy (SRT) offers high efficacy but poses risks of significant toxicity.
• Prospective peer review is essential for optimizing SRT treatment plans and patient safety.

Purpose of the Study:

• To identify factors associated with SRT plan revisions within a prospective peer review program.
• To evaluate the impact of physician experience and case volume on SRT plan quality.

Main Methods:

• A prospective peer review program involving weekly rounds for SRT cases was established.
• Case revision recommendations were tracked, and logistic regression analysis was used to identify significant factors.
• Data included 1172 SRT cases (SRS, multi-fractionated SRS, stereotactic body radiation therapy) reviewed between 2019 and 2024.

Main Results:

• The yearly revision rate varied from 19% to 31% over the study period.
• Multivariable analysis revealed that high-volume physicians (OR, 0.58) and those with 3-9 years of experience (OR, 0.65) were less likely to have plans revised.
• Stereotactic radiosurgery (SRS) technique was also associated with fewer revisions (OR, 0.59).

Conclusions:

• Prospective peer review is highly valuable, particularly for physicians with low case volume and early in their careers.
• Adequate case volume appears critical for high-quality SRT, similar to findings in surgical literature.
• Substantial annual revision rates underscore the continued importance of robust prospective peer review for SRT.