Advances in Radiation Oncology (Oct 2019)

The Special Medical Physics Consult Process for Reirradiation Patients

  • Kelly C. Paradis, PhD,
  • Charles Mayo, PhD,
  • Dawn Owen, MD,
  • Daniel E. Spratt, MD,
  • Jason Hearn, MD,
  • Benjamin Rosen, PhD,
  • Rojano Kashani, PhD,
  • Jean Moran, PhD,
  • Daniel S. Tatro, CMD,
  • Whitney Beeler, MD,
  • Karen Vineberg, CMD,
  • Dylan C. Smith, MS,
  • Martha M. Matuszak, PhD

Journal volume & issue
Vol. 4, no. 4
pp. 559 – 565

Abstract

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Purpose: To present a systematic approach to the reirradiation special medical physics consult (ReRT-SMPC) process. Materials and Methods: An in-house reirradiation committee of physicians and physicists was formed to develop a streamlined and well-documented approach to ReRT-SMPCs. Dosimetric goals and considerations for tissue repair were generated by the committee with input from the literature, clinical trial guidelines, and physician experience. Procedural workflow was also defined. Results: The total number of ReRT-SMPCs performed in our department in 2018 was 401, corresponding to 369 unique patients and 16% of the total number of patients receiving external beam radiation in our department that year. This constituted a large increase over the 183 ReRT-SMPCs performed in 2017. We have found that a standardized ReRT-SMPC workflow helps to safeguard patients, documents the clinical decision-making process for medical and legal purposes, and facilitates the peer-review process. The data being collected from each consult along with toxicity and outcomes data can be used to help inform future re-treatment guidelines. Conclusions: As the number of patients returning for additional courses of radiation continues to increase, a uniform method for the ReRT-SMPC workflow and analysis is a powerful tool for ensuring patient safety, understanding and predicting treatment toxicity, and refining reirradiation dosimetric limits.