Salvage stereotactic body radiotherapy (SBRT) for intraprostatic relapse after prostate cancer radiotherapy: An ESTRO ACROP Delphi consensus. (July 2021)

• Record Type: Journal Article
• Authors: Jereczek-Fossa, Barbara A.; Marvaso, Giulia; Zaffaroni, Mattia; Gugliandolo, Simone Giovanni; Zerini, Dario; Corso, Federica; Gandini, Sara; Alongi, Filippo; Bossi, Alberto; Cornford, Philip; De Bari, Berardino; Fonteyne, Valérie; Hoskin, Peter; Pieters, Bradley R.; Tree, Alison C.; Arcangeli, Stefano; Fuller, Donald B.; Franzese, Ciro; Hannoun-Levi, Jean-Michel; Janoray, Guillaume; Kerkmeijer, Linda; Kwok, Young; Livi, Lorenzo; Loi, Mauro; Miralbell, Raymond; Pasquier, David; Pinkawa, Michael; Scher, Nathaliel; Scorsetti, Marta; Shelan, Mohamed; Toledano, Alain; van As, Nicholas; Vavassori, Andrea; Zilli, Thomas; Pepa, Matteo; Ost, Piet;
• Is Part Of: Cancer treatment reviews. Volume 98(2021)
• Publication Date: 2021-07
• Subjects: Recurrent prostate cancer -- Salvage radiotherapy -- Stereotactic body radiotherapy -- Delphi consensus; ACROP Advisory Committee on Radiation Oncology Practice -- AIRO Italian Association of Radiotherapy and Clinical Oncology -- ADT Androgen deprivation therapy -- ASTRO American Society for Therapeutic Radiology and Oncology -- BT Brachytherapy -- CTV Clinical target volume -- EAU European Association of Urology -- EBRT External beam radiotherapy -- ECOG Eastern Cooperative Oncology Group -- ESTRO European SocieTy for Radiotherapy and Oncology -- IC Internal Committee -- IPSS International Prostate Symptom Score -- G Grade -- GEC Groupe Européen de Curiethérapie -- GTV Gross tumour volume -- HDR-BT High dose-rate BT -- Kendall's W Kendall's coefficient of concordance -- MADM Mean absolute deviation from the median -- mp-MRI Multiparametric MRI -- MRI Magnetic resonance imaging -- NRG National Surgical Adjuvant Breast and Bowel Project (NSABP) Radiation Therapy Oncology Group (RTOG) Gynecologic Oncology Group (GOG) -- OAR Organ at risk -- PCa Prostate cancer -- PET Positron emission tomography -- ProtecT Prostate Testing for Cancer and Treatment -- PSA Prostate-specific antigen -- PSMA Prostate-specific membrane antigen -- QoL Quality of life -- RC Reviewing Committee -- RP Radical prostatectomy -- RT Radiotherapy -- SBRT Stereotactic body radiotherapy -- US Ultrasound -- WC Writing Committee; Cancer -- Periodicals; Cancer -- Treatment -- Periodicals; Neoplasms -- therapy -- Periodicals; Cancer -- Périodiques; Cancer -- Traitement -- Périodiques; Cancer -- Treatment; Electronic journals; Periodicals; 616.99406
• DOI: 10.1016/j.ctrv.2021.102206
• Languages: English
• ISSNs: 0305-7372

Abstract

Highlights: Between 30% and 47% of PCa patients are at risk of intraprostatic recurrence. ADT, the standard of care, represents a serious burden in terms of QoL. Purpose of this ESTRO ACROP project is to collect experts' opinion on salvage SBRT. Low consensus was achieved, highlighting the need for further investigations. The present Delphi consensus may serve as a practical guidance for salvage SBRT. Abstract: Background and purpose: Between 30% and 47% of patients treated with definitive radiotherapy (RT) for prostate cancer are at risk of intraprostatic recurrence during follow-up. Re-irradiation with stereotactic body RT (SBRT) is emerging as a feasible and safe therapeutic option. However, no consensus or guidelines exist on this topic. The purpose of this ESTRO ACROP project is to investigate expert opinion on salvage SBRT for intraprostatic relapse after RT. Materials and Methods: A 40-item questionnaire on salvage SBRT was prepared by an internal committee and reviewed by a panel of leading radiation oncologists plus a urologist expert in prostate cancer. Following the procedure of a Delphi consensus, 3 rounds of questionnaires were sent to selected experts on prostate re-irradiation. Results: Among the 33 contacted experts, 18 (54.5%) agreed to participate. At the end of the final round, participants were able to find consensus on 14 out of 40 questions (35% overall) and major agreement on 13 questions (32.5% overall). Specifically, the consensus was reached regarding some selection criteria (no age limit, ECOG 0–1, satisfactory urinary flow), diagnostic procedures (exclusion of metastatic disease, SBRT target defined on the MRI) and therapeutic approach (no need for concomitant ADT, consideration of the first RT dose, validity of Phoenix criteria for salvage SBRT failure). Conclusion: While awaiting the results of ongoing studies, our ESTRO ACROP Delphi consensus may serve as a practical guidance for salvage SBRT. Future research should address the existing disagreements on this promising approach.