Vilotte F, Pasquier D, Blanchard P, Supiot S, Khalifa J, Schick U, Lacornerie T, Vieillevigne L, Marre D, Chapet O, Latorzeff I, Magne N, Meyer E, Cao K, Belkacemi Y, Bibault J E, Berge-Lefranc M, Faivre J C, Gnep K, Guimas V, Hasbini A, Langrand-Escure J, Hennequin C, Graff P
Department of Radiation Oncology, Institut Bergonié, 229 Cours de l'Argonne, 33076 Bordeaux, France.
Department of Radiation Oncology, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59000 Lille, France.
Clin Transl Radiat Oncol. 2022 Aug 8;37:33-40. doi: 10.1016/j.ctro.2022.08.006. eCollection 2022 Nov.
The relevance of metastasis-directed stereotactic body radiation therapy (SBRT) remains to be demonstrated through phase III trials. Multiple SBRT procedures have been published potentially resulting in a disparity of practices. Therefore, the french society of urological radiation oncolgists (GETUG) recognized the need for joint expert consensus guidelines for metastasis-directed SBRT in order to standardize practice in trials carried out by the group.
After a comprehensive literature review, 97 recommendation statements were created regarding planning and delivery of spine bone (SBM) and non-spine bone metastases (NSBM) SBRT. These statements were then submitted to a national online two-round modified Delphi survey among main GETUG investigators. Consensus was achieved if a statement received ≥ 75 % agreements, a trend to consensus being defined as 65-74 % agreements. Any statement without consensus at round one was re-submitted in round two.
Twenty-one out of 29 (72.4%) surveyed experts responded to both rounds. Seventy-five statements achieved consensus at round one leaving 22 statements needing a revote of which 16 achieved consensus and 5 a trend to consensus. The final rate of consensus was 91/97 (93.8%). Statements with no consensus concerned patient selection (3/19), dose and fractionation (1/11), prescription and dose objectives (1/9) and organs at risk delineation (1/15). The voting resulted in the writing of step-by-step consensus guidelines.
Consensus guidelines for SBM and NSBM SBRT were agreed upon using a validated modified Delphi approach. These guidelines will be used as per-protocole recommendations in ongoing and further GETUG clinical trials.
转移灶定向立体定向体部放疗（SBRT）的相关性仍有待通过III期试验来证实。已有多篇关于SBRT程序的文章发表，这可能导致实践上的差异。因此，法国泌尿生殖系统放射肿瘤学会（GETUG）认识到需要制定针对转移灶定向SBRT的联合专家共识指南，以便规范该组织开展的试验中的实践操作。
在全面的文献综述之后，针对脊柱骨转移（SBM）和非脊柱骨转移（NSBM）的SBRT计划制定与实施，制定了97条推荐声明。然后将这些声明提交给GETUG主要研究人员进行全国性的两轮在线改良德尔菲调查。如果一条声明获得≥75%的同意票，则达成共识，65%-74%的同意票被定义为有达成共识的趋势。在第一轮没有达成共识的任何声明将在第二轮重新提交。
29位接受调查的专家中有21位（72.4%）回复了两轮调查。75条声明在第一轮达成了共识，22条声明需要重新投票，其中16条达成了共识，5条有达成共识的趋势。最终的共识率为91/97（93.8%）。未达成共识的声明涉及患者选择（3/19）、剂量与分割（1/11）、处方与剂量目标（1/9）以及危及器官的勾画（1/15）。投票结果形成了逐步的共识指南。
采用经过验证的改良德尔菲方法达成了关于SBM和NSBM的SBRT共识指南。这些指南将作为GETUG正在进行和未来临床试验中的按方案推荐。
