Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK.
School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
BMJ Open. 2022 Jul 20;12(7):e060506. doi: 10.1136/bmjopen-2021-060506.
To identify consensus on patient prioritisation for rectal hydrogel spacer use during radiation therapy for the treatment of prostate cancer in the UK.
Delphi study consisting of two rounds of online questionnaires, two virtual advisory board meetings and a final online questionnaire.
Radical radiation therapy for localised and locally advanced prostate cancer in the UK.
Six leading clinical oncologists and one urologist from across the UK.
Rectal hydrogel spacer.
None reported.
The panel reached consensus on the importance of minimising toxicity for treatments with curative intent and that even low-grade toxicity-related adverse events can significantly impact quality of life. There was agreement that despite meeting rectal dose constraints, too many patients experience rectal toxicity and that rectal hydrogel spacers in eligible patients significantly reduces toxicity-related adverse events. However, as a consequence of funding limitations, patients need to be prioritised for spacer use. A higher benefit of spacers can be expected in patients on anticoagulation and in patients with diabetes or inflammatory bowel disease, but consensus could not be reached regarding patient groups expected to benefit less. While radiation therapy regimen is not a main factor determining prioritisation, higher benefit is expected in ultrahypofractionated regimens.
There is a strong and general agreement that all patients with prostate cancer undergoing radical radiation therapy have the potential to benefit from hydrogel spacers. Currently, not all patients who could potentially benefit can access hydrogel spacers, and access is unequal. Implementation of the consensus recommendations would likely help prioritise and equalise access to rectal spacers for patients in the UK.
在英国，为治疗前列腺癌而进行放射治疗时，确定对直肠水凝胶间隔物使用进行患者优先排序的共识。
由两轮在线问卷调查、两次虚拟顾问委员会会议和最终的在线问卷调查组成的德尔菲研究。
英国局部和局部晚期前列腺癌的根治性放射治疗。
来自英国各地的六名领先的临床肿瘤学家和一名泌尿科医生。
直肠水凝胶间隔物。
未报告。
专家组就以下几点达成共识：为具有治愈意图的治疗最大限度地减少毒性的重要性，即使是低度毒性相关的不良事件也会显著影响生活质量。一致认为，尽管满足直肠剂量限制，但仍有太多患者出现直肠毒性，而在合适的患者中使用直肠水凝胶间隔物可显著减少与毒性相关的不良事件。然而，由于资金限制，需要对患者进行优先排序以使用间隔物。在接受抗凝治疗的患者和患有糖尿病或炎症性肠病的患者中，间隔物的获益更高，但对于预期获益较低的患者群体，专家组无法达成共识。虽然放射治疗方案不是确定优先顺序的主要因素，但超分割方案的获益更高。
有强烈且普遍的共识认为，所有接受根治性放射治疗的前列腺癌患者都有可能从水凝胶间隔物中获益。目前，并非所有可能受益的患者都能获得水凝胶间隔物，而且获得途径也不平等。实施共识建议可能有助于为英国的患者优先考虑并平等获得直肠间隔物。
