Abstract：
OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
目的：根据ICRU报告91，制定关于立体定向全身放疗（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实践以及完善临床试验设计的剂量处方和文档要求的基础步骤。
方法：根据工作组的文献综述结果，来自三个欧洲国家的24名医生和物理学专家进行了两级Delphi共识过程.对于总体（OA）和器官特异性（OS）声明（≥80％，60-79%,<60%为高，中间,和糟糕的共识，分别)。第一轮后的陈述在德尔菲进程第二轮的现场讨论中得到了完善。
结果：专家同意关于原发性和继发性肺SBRT的14项OA和17项OS声明，肝脏,胰腺,肾上腺,和肾脏肿瘤关于剂量处方，目标覆盖率,和危险器官的剂量限制。在79%和41%的OA和OS声明中，同意度≥80%，分别,与上腹部相比，肺的共识更高。在第2轮中，OA的同意程度为≥80％至100％，OS声明中为88％。对于化疗后肝转移的剂量递增（47％）或原发性肾脏的单次SBRT（13％）未达成共识。在第2轮中，没有一个声明有60-79%的共识。
结论：在31份声明中的29份中，经过两级Delphi过程后达成了高度共识，其中一份声明（肾脏）被明确拒绝。Delphi方法能够对SBRT剂量处方达成高度共识。总之,可以定义OA和OS的明确建议。这极大地促进了SBRT实践的协调，并促进了研究SBRT的临床试验中的剂量处方和报告。
方法：根据工作组的文献综述结果，来自三个欧洲国家的24名医生和物理学专家进行了两级Delphi共识过程.对于总体（OA）和器官特异性（OS）声明（≥80％，60-79%,<60%为高，中间,和糟糕的共识，分别)。第一轮后的陈述在德尔菲进程第二轮的现场讨论中得到了完善。
结果：专家同意关于原发性和继发性肺SBRT的14项OA和17项OS声明，肝脏,胰腺,肾上腺,和肾脏肿瘤关于剂量处方，目标覆盖率,和危险器官的剂量限制。在79%和41%的OA和OS声明中，同意度≥80%，分别,与上腹部相比，肺的共识更高。在第2轮中，OA的同意程度为≥80％至100％，OS声明中为88％。对于化疗后肝转移的剂量递增（47％）或原发性肾脏的单次SBRT（13％）未达成共识。在第2轮中，没有一个声明有60-79%的共识。
结论：在31份声明中的29份中，经过两级Delphi过程后达成了高度共识，其中一份声明（肾脏）被明确拒绝。Delphi方法能够对SBRT剂量处方达成高度共识。总之,可以定义OA和OS的明确建议。这极大地促进了SBRT实践的协调，并促进了研究SBRT的临床试验中的剂量处方和报告。
