Consensus Quality Measures and Dose Constraints for Lung Cancer from the Veterans Affairs Radiation Oncology Quality Surveillance Program and American Society for Radiation Oncology (ASTRO) Expert Panel

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Pract Radiat Oncol


INTRODUCTION: For patients with lung cancer, it is critical to provide evidence-based radiation therapy to ensure high quality care. The VA National Radiation Oncology Program (VA NROP) partnered with the American Society for Radiation Oncology (ASTRO) as part of the VA Radiation Oncology Quality Surveillance (VA ROQS) to develop lung cancer quality metrics and assess quality of care as a pilot program in 2016. Herein, we present recently updated consensus quality measures and dose-volume histogram (DVH) constraints.

METHODS: A series of measures and performance standards were reviewed and developed by a Blue-Ribbon Panel of lung cancer experts in conjunction with ASTRO in 2022. As part of this initiative, quality, surveillance, and aspirational metrics were developed for a) Initial Consultation and Work Up, b) Simulation, Treatment Planning, and Treatment Delivery, and c) Follow Up. DVH metrics for target and organ at risk treatment planning dose constraints were also reviewed and defined.

RESULTS: Altogether, a total of 19 lung cancer quality metrics were developed. There were 121 DVH constraints developed for various fractionation regimens including ultrahypofractionated (1,3,4,5 fraction[s]), hypofractionated (10 and 15 fractionations), and conventional fractionation (30-35 fractions).

CONCLUSIONS: The devised measures will be implemented for quality surveillance for Veterans both inside and outside of the VA system, as well as provide a resource for lung cancer specific quality metrics. The recommended DVH constraints serve as a unique, comprehensive resource for evidence and expert-consensus based constraints across multiple fractionation schemas.

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ePub ahead of print