Department of Radiation Oncology, Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria.
Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, 8036, Graz, Austria.
Strahlenther Onkol. 2024 Sep;200(9):737-750. doi: 10.1007/s00066-024-02254-2. Epub 2024 Jul 12.
To develop expert consensus statements on multiparametric dose prescriptions for stereotactic body radiotherapy (SBRT) aligning with ICRU report 91. These statements serve as a foundational step towards harmonizing current SBRT practices and refining dose prescription and documentation requirements for clinical trial designs.
Based on the results of a literature review by the working group, a two-tier Delphi consensus process was conducted among 24 physicians and physics experts from three European countries. The degree of consensus was predefined for overarching (OA) and organ-specific (OS) statements (≥ 80%, 60-79%, < 60% for high, intermediate, and poor consensus, respectively). Post-first round statements were refined in a live discussion for the second round of the Delphi process.
Experts consented on a total of 14 OA and 17 OS statements regarding SBRT of primary and secondary lung, liver, pancreatic, adrenal, and kidney tumors regarding dose prescription, target coverage, and organ at risk dose limitations. Degree of consent was ≥ 80% in 79% and 41% of OA and OS statements, respectively, with higher consensus for lung compared to the upper abdomen. In round 2, the degree of consent was ≥ 80 to 100% for OA and 88% in OS statements. No consensus was reached for dose escalation to liver metastases after chemotherapy (47%) or single-fraction SBRT for kidney primaries (13%). In round 2, no statement had 60-79% consensus.
In 29 of 31 statements a high consensus was achieved after a two-tier Delphi process and one statement (kidney) was clearly refused. The Delphi process was able to achieve a high degree of consensus for SBRT dose prescription. In summary, clear recommendations for both OA and OS could be defined. This contributes significantly to harmonization of SBRT practice and facilitates dose prescription and reporting in clinical trials investigating SBRT.
制定与 ICRU 报告 91 一致的立体定向体部放疗（SBRT）多参数剂量处方的专家共识声明。这些声明是协调当前 SBRT 实践和完善剂量处方和临床试验设计文件要求的基础步骤。
基于工作组的文献回顾结果，在来自三个欧洲国家的 24 名医生和物理专家中进行了两级 Delphi 共识过程。对于总体（OA）和器官特异性（OS）声明，共识程度是预先定义的（≥80%、60-79%、<60%分别为高、中、低共识）。第一轮后的声明在第二轮 Delphi 过程的现场讨论中进行了细化。
专家们就原发性和继发性肺、肝、胰腺、肾上腺和肾肿瘤的 SBRT 剂量处方、靶区覆盖和危及器官剂量限制达成了总共 14 项 OA 和 17 项 OS 声明。OA 和 OS 声明的共识程度分别为≥80%和 79%和 41%，其中肺部的共识程度更高。在第二轮中，OA 和 OS 声明的共识程度分别为≥80 到 100%和 88%。化疗后肝转移的剂量递增（47%）或单次 SBRT 治疗肾原发肿瘤（13%）未达成共识。在第二轮中，没有声明的共识程度为 60-79%。
在两轮 Delphi 过程后，29 项声明中的 29 项达成了高度共识，只有一项（肾脏）被明确拒绝。德尔菲过程能够为 SBRT 剂量处方达成高度共识。总之，可以为 OA 和 OS 明确定义推荐建议。这为 SBRT 实践的协调以及调查 SBRT 的临床试验中的剂量处方和报告提供了重要支持。
