Impact of Multiprofessional Radiotherapy Peer Review on Multidisciplinary Team Meeting Staging in Head and Neck Cancer

Aims: Cancer staging is routinely done in a multidisciplinary team meeting (MDM). There is however no established quality assurance (QA) for MDM-recorded cancer staging. Conversely, radiotherapy peer review is a recommended QA process. This study aimed to compare the cancer staging of the multiprofessional radiotherapy peer review (with radiologists) against the referring MDMs. Materials and methods: All head and neck intensity-modulated radiotherapy (IMRT) cases discussed in peer review between May 2023 to April 2024 were prospectively evaluated. Any radiological disease progression (PD) on IMRT-planning scan since the diagnostic scans, and patients' cancer staging, were prospectively recorded. These were compared with the MDM-recorded outcomes data. Results: A total of 235 IMRT cases were peer-reviewed: 166 definitive, 63 post-operative and 6 palliatives. Of the analysable definitive cases, 44/150 (29%) were found to have PD, with a mean interval from diagnostic to IMRT-planning scan of 51 days (Standard Deviation SD = 25), compared to 38 days (SD = 21) in the cohort without PD (p < 0.01). After the exclusion of 28 patients with the most advanced non-metastatic stage, 35 (30%) were upstaged with a mean interval from diagnostic to IMRT-planning of 49 days (SD = 26), compared to 39 days (SD = 23) in the cohort without upstage (p = 0.05). Twenty (57%) upstaged patients had evidence of PD, while the other 15 (43%) were upstaged despite the absence of PD. Two MDM-recorded T3-category larynx cancers were subsequently recommended for a primary laryngectomy due to T4a-category at peer review, and both were proven T4a pathologically. Three upstaged patients were recommended concomitant chemotherapy. The peer review recommended IMRT volume changes to 156 (66%) patients. Conclusion: Discrepancies in MDM staging can occur, and a protracted diagnosis and treatment pathway too can affect final cancer staging. Routine radiologist input in peer review can provide crucial post-MDM outcome assurance and the recommended clinical management. Crown Copyright (c) 2024 Published by Elsevier Ltd on behalf of The Royal College of Radiologists. All rights are reserved, including those for text and data mining, AI training, and similar technologies.