Rowe Lindsay S, Mandia Jeremy J, Salerno Kilian E, Shankavaram Uma T, Das Shaoli, Escorcia Freddy E, Ning Holly, Citrin Deborah E
Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada.
Walter Reed National Military Medical Center, Washington, DC.
Adv Radiat Oncol. 2022 Feb 3;7(5):100902. doi: 10.1016/j.adro.2022.100902. eCollection 2022 Sep-Oct.
Optimal management of patients with prostate cancer (PCa) to achieve bowel and bladder reproducibility for radiation therapy (RT) and the appropriate planning target volume (PTV) expansions for use with modern image guidance is uncertain. We surveyed American Society of Radiation Oncology radiation oncologists to ascertain practice patterns for definitive PCa RT with respect to patient instructions and set up, daily image guidance, and subsequent PTV expansions.
A pattern of practice survey was sent to American Society of Radiation Oncology radiation oncologists who self-identified as specializing in PCa. Respondents identified the fractionation regimens routinely used, and their practices regarding diet, bowel, and bladder instructions for patients with PCa before RT simulation and throughout treatment. Questions regarding PTV margins, daily set up practices, and use of image guidance were included.
Of 190 respondents, 158 reported using conventional fractionation (CFx), 49 moderate hypofractionation (MHFx), and 61 stereotactic body radiation therapy (SBRT). Diet modifications during RT were advised by 84% of respondents, treatment with full bladder by 96%, and bowel instructions by 78%. Prescription of bowel medication was higher for respondents using SBRT (95.1%) versus those using CFx/MHFx (55.1%; 34.7%). The most common implantable device reported was fiducial markers, with increased use in SBRT (86.0%; 68.9%) versus CFx/MHFx. Cone beam computed tomography was the most common daily imaging technique across fractionation regimens. SBRT showed correlation between PTV margin expansions, fiducial marker use, and image guidance.
Survey results indicate heterogeneity in treatment modality, dose, patient instructions, and PTV expansions used by radiation oncologists in the treatment of patients with PCa. Further investigation to define appropriate patient instructions on bowel preparation to maximize target reproducibility in PCa is needed, as is continued guidance on evidence-based approaches for image guidance and PTV margin selection.
前列腺癌（PCa）患者的最佳管理，以实现放射治疗（RT）中肠道和膀胱的可重复性，以及与现代图像引导配合使用的合适计划靶体积（PTV）扩展尚不确定。我们对美国放射肿瘤学会的放射肿瘤学家进行了调查，以确定在患者指导、设置、每日图像引导以及后续PTV扩展方面确定性PCa RT的实践模式。
向自我认定为专门从事PCa治疗的美国放射肿瘤学会放射肿瘤学家发送了一份实践模式调查问卷。受访者确定了常规使用的分割方案，以及他们在RT模拟前和整个治疗过程中对PCa患者的饮食、肠道和膀胱指导的做法。还包括有关PTV边界、每日设置做法和图像引导使用的问题。
在190名受访者中，158人报告使用常规分割（CFx），49人使用中等程度的低分割（MHFx），61人使用立体定向体部放射治疗（SBRT）。84%的受访者建议在RT期间进行饮食调整，96%建议膀胱充盈时进行治疗，78%建议进行肠道指导。使用SBRT的受访者（95.1%）开具肠道药物的比例高于使用CFx/MHFx的受访者（55.1%；34.7%）。报告最多的可植入装置是基准标记物，SBRT中的使用比例（86.0%）高于CFx/MHFx（68.9%）。锥形束计算机断层扫描是所有分割方案中最常用的每日成像技术。SBRT显示PTV边界扩展、基准标记物使用和图像引导之间存在相关性。
调查结果表明，放射肿瘤学家在PCa患者治疗中使用的治疗方式、剂量、患者指导和PTV扩展存在异质性。需要进一步研究以确定关于肠道准备的适当患者指导，以最大限度提高PCa中的靶区可重复性，同时也需要继续提供关于图像引导和PTV边界选择的循证方法的指导。
