未经授权:骨转移的局部治疗变得越来越复杂。国家指南传统上只关注放射治疗(RT),在临床医生可用的临床决策支持资源方面留下了空白。这项研究的目的是就非脊柱骨转移的多学科管理达成专家共识。这将促进学术团体伙伴关系内的标准化治疗。
UNASSIGNED:在纪念斯隆·凯特琳(MSK)癌症联盟中治疗转移性疾病的多学科医生小组,包括基于社区的合作伙伴网站,被召集。通过调查确定了在非脊柱骨转移治疗中具有重要意义的临床问题。进行了文献综述,小组医师起草了初步建议声明.通过修改的德尔菲程序,由17名放射肿瘤学医生组成的完整小组就建议声明达成了共识,骨科手术,医学肿瘤学,介入放射学,麻醉疼痛。共识是先验定义为75%的受访者表示“同意”或“强烈同意”共识声明。推荐分类强度用于为每个陈述分配证据强度。
未经证实:确定了17个临床问题,其中11人(65%)被选入共识进程。17个回答陈述中有16个达成共识(94%),其中12个在修改后的德尔福投票程序的第1轮后获得批准,另外4个在第2轮后获得批准。主题包括转诊手术或介入放射学的适应症,辐射分馏和适当使用立体定向方法,以及放疗期间全身治疗的处理。证据强度最常见的是C(n=7),其次是B(n=5)和A(n=3)。
UNASSIGNED:由社区和学术医师组成的多学科小组之间达成共识治疗非脊柱骨转移是可行的。建议将有助于临床医生,并可能提供措施,以减少不同实践设置之间的差异。研究结果突出了进一步研究的领域,如病理性骨折风险估计,术前放射,和经皮消融。
UNASSIGNED: Local treatment for bone metastases is becoming increasingly complex. National
guidelines traditionally focus only on radiation therapy (RT), leaving a gap in clinical decision support resources available to clinicians. The objective of this study was to reach expert
consensus regarding multidisciplinary management of non-spine bone metastases, which would facilitate standardizing treatment within an academic-community partnership.
UNASSIGNED: A multidisciplinary panel of physicians treating metastatic disease across the Memorial Sloan Kettering (MSK) Cancer Alliance, including community-based partner sites, was convened. Clinical questions rated of high importance in the management of non-spine bone metastases were identified via survey. A literature review was conducted, and panel physicians drafted initial recommendation statements.
Consensus was gathered on recommendation statements through a modified Delphi process from a full panel of 17 physicians from radiation oncology, orthopaedic surgery, medical oncology, interventional radiology, and anesthesia pain.
Consensus was defined a priori as 75% of respondents indicating \"agree\" or \"strongly agree\" with the
consensus statement. Strength of Recommendation Taxonomy was employed to assign evidence strength for each statement.
UNASSIGNED: Seventeen clinical questions were identified, of which 11 (65%) were selected for the consensus process. Consensus was reached for 16 of 17 answer statements (94%), of which 12 were approved after Round 1 and additional 4 approved after Round 2 of the modified Delphi voting process. Topics included indications for referral to surgery or interventional radiology, radiation fractionation and appropriate use of stereotactic approaches, and the handling of systemic therapies during radiation. Evidence strength was most commonly C (n = 7), followed by B (n = 5) and A (n = 3).
UNASSIGNED: Consensus among a multidisciplinary panel of community and academic physicians treating non-spine bone metastases was feasible. Recommendations will assist clinicians and potentially provide measures to reduce variation across diverse practice settings. Findings highlight areas for further research such as pathologic fracture risk estimation, pre-operative radiation, and percutaneous ablation.