Abstract：
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.
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.
摘要：
在英国前列腺癌放射治疗期间，确定患者优先使用直肠水凝胶垫片的共识。
德尔菲研究由两轮在线问卷组成，两次虚拟顾问委员会会议和一份最终的在线问卷。
英国局部和局部晚期前列腺癌的根治性放射治疗。
来自英国各地的六位领先的临床肿瘤学家和一位泌尿科医生。
直肠水凝胶垫片。
无报告。
专家组就最小化具有治疗目的的治疗毒性的重要性达成共识，即使是低度毒性相关的不良事件也会显著影响生活质量。人们一致认为，尽管满足直肠剂量限制，太多的患者出现直肠毒性,符合条件的患者的直肠水凝胶间隔物显著减少了与毒性相关的不良事件.然而,由于资金的限制，患者需要优先使用垫片。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，可以预期间隔物的更高益处。但对于预期获益较少的患者群体未能达成共识.虽然放射治疗方案不是决定优先次序的主要因素，超分割方案有望获得更高的益处。
有一个强烈和普遍的共识，即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受益。目前,并非所有可能受益的患者都可以使用水凝胶垫片，访问是不平等的。实施共识建议可能有助于优先考虑和平衡英国患者对直肠间隔器的使用。
德尔菲研究由两轮在线问卷组成，两次虚拟顾问委员会会议和一份最终的在线问卷。
英国局部和局部晚期前列腺癌的根治性放射治疗。
来自英国各地的六位领先的临床肿瘤学家和一位泌尿科医生。
直肠水凝胶垫片。
无报告。
专家组就最小化具有治疗目的的治疗毒性的重要性达成共识，即使是低度毒性相关的不良事件也会显著影响生活质量。人们一致认为，尽管满足直肠剂量限制，太多的患者出现直肠毒性,符合条件的患者的直肠水凝胶间隔物显著减少了与毒性相关的不良事件.然而,由于资金的限制，患者需要优先使用垫片。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，可以预期间隔物的更高益处。但对于预期获益较少的患者群体未能达成共识.虽然放射治疗方案不是决定优先次序的主要因素，超分割方案有望获得更高的益处。
有一个强烈和普遍的共识，即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受益。目前,并非所有可能受益的患者都可以使用水凝胶垫片，访问是不平等的。实施共识建议可能有助于优先考虑和平衡英国患者对直肠间隔器的使用。
