Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania.
JAMA Netw Open. 2021 Apr 1;4(4):e213531. doi: 10.1001/jamanetworkopen.2021.3531.
Packed red blood cell (PRBC) transfusions are used to treat anemia in patients with cervical cancer undergoing radiotherapy (RT) owing to concerns of hypoxia-induced radioresistance. In the absence of high-quality evidence informing transfusion practices for patients receiving external beam RT (EBRT) and brachytherapy, various arbitrary hemoglobin target levels are used worldwide.
To develop consensus statements to guide PRBC transfusion practices in patients with cervical cancer receiving curative-intent RT with EBRT and brachytherapy.
DESIGN, SETTING, AND PARTICIPANTS: This international Delphi consensus study was completed between November 1, 2019, and July 31, 2020. A total of 63 international clinical experts in gynecologic radiation oncology were invited; 39 (62%) accepted and consented to participate. Consensus building was achieved using a 3-round anonymous Delphi consensus method. Participants rated their agreement or disagreement with statements using a 5-point Likert scale. An a priori threshold of 75% or more was required for consensus.
The preplanned primary outcome of this study was to assess hemoglobin transfusion thresholds and targets for both EBRT and brachytherapy by expert consensus.
Response rates of 100% (39 of 39), 92% (36 of 39), and 97% (35 of 36) were achieved for the first, second, and third rounds of surveys, respectively. Twenty-three experts (59%) practiced in Canada, 11 (28%) in the United States, 3 (8%) in South America, 1 (3%) in Europe, and 1 (3%) in Asia. Consensus was reached for 44 of 103 statements (43%), which were combined to form the final 27-statement consensus guideline. No specific hemoglobin transfusion threshold was agreed on by consensus for EBRT or brachytherapy. By consensus (89% [31 of 35]), a hemoglobin transfusion target for patients who receive a PRBC transfusion should be 9 g/dL or more and less than 12 g/dL.
This study presents the first international expert consensus guideline informing PRBC transfusion practices for patients with cervical cancer undergoing EBRT and brachytherapy. A minimum hemoglobin transfusion target of 9 g/dL was endorsed to balance tumor radiosensitivity with appropriate use of a scarce resource. Randomized clinical trials are required to evaluate the optimal transfusion threshold and target that maximize clinical benefit in this patient population.
由于担心缺氧诱导的放射抗性，接受放射治疗 (RT) 的宫颈癌患者会使用浓缩红细胞 (PRBC) 输血来治疗贫血。在缺乏有关接受外照射 RT (EBRT) 和近距离放射治疗的患者输血实践的高质量证据的情况下，世界各地使用了各种任意的血红蛋白目标水平。
制定共识声明，以指导接受 EBRT 和近距离放射治疗的宫颈癌患者的 PRBC 输血实践。
设计、地点和参与者：这项国际德尔菲共识研究于 2019 年 11 月 1 日至 2020 年 7 月 31 日完成。共邀请了 63 名国际妇科放射肿瘤学临床专家；其中 39 名（62%）接受并同意参与。使用 3 轮匿名德尔菲共识方法达成共识。参与者使用 5 分李克特量表对陈述表示同意或不同意。预先设定的共识阈值为 75%或更高。
该研究的预定主要结果是通过专家共识评估 EBRT 和近距离放射治疗的血红蛋白输血阈值和目标。
第一轮、第二轮和第三轮调查的回复率分别为 100%（39/39）、92%（36/39）和 97%（35/36）。23 名专家（59%）在加拿大执业，11 名（28%）在美国，3 名（8%）在南美洲，1 名（3%）在欧洲，1 名（3%）在亚洲。就 103 项声明中的 44 项达成共识（43%），将这些声明合并形成最终的 27 项共识指南。对于 EBRT 或近距离放射治疗，没有达成具体的血红蛋白输血阈值共识。通过共识（89%[31/35]），接受 PRBC 输血的患者的血红蛋白输血目标应为 9g/dL 或更高且小于 12g/dL。
本研究提出了第一个指导接受 EBRT 和近距离放射治疗的宫颈癌患者 PRBC 输血实践的国际专家共识指南。支持血红蛋白输血目标最低值为 9g/dL，以平衡肿瘤放射敏感性与稀缺资源的合理使用。需要随机临床试验来评估该患者人群中最大化临床获益的最佳输血阈值和目标。
