背景:对寡转移前列腺癌(OMPC)的兴趣正在增加,和各种临床研究报道了转移定向放射治疗(MDRT)在OMPC中的益处。然而,对通过的定义的承认,评估方法,放射肿瘤学家的治疗方法多种多样。这项研究旨在评估放射肿瘤学家对OMPC问题的共识水平。
方法:我们为OMPC生成了15个与定义相关的关键问题(KQs),诊断,局部疗法,和端点。此外,代表同步转移性前列腺癌(mPC)的三种临床方案(病例1),异时性mPC伴内脏转移(病例2),并发展了具有去势抵抗和多转移史的异时mPC(病例3)。根据每个场景对15个KQ进行了调整,并转换为23个问题,每个场景6-9个。调查已分发给大韩民国各地的80名放射肿瘤学家。答案选项为0.0-29.9%,30-49.9%,50-69.9%,70-79.9%,80-89.9%,90-100%的协议被认为是否定的,最小,弱,中度,坚强,和近乎完美的协议,分别。
结果:45名候选人自愿参加了这项研究。在23个问题中,接近完美(n=4),强(n=3),或中等(n=2)协议显示在9个。对于承认为OMPC且协议为93%的案例(案例1),在对整个转移性病变应用确定性放射治疗(RT)方面达成了近乎完美的协议。虽然尚未达成关于转移定向RT(MDRT)最佳剂量分级的≥70%协议,立体定向体RT(SBRT)受到临床容量较高的临床医生的青睐。
结论:对于公认为OMPC的案例,对于整个转移性病变的最终RT应用,达成了近乎完美的协议。SBRT作为MDRT更受临床量较高的临床医生的青睐。
BACKGROUND: Interest in the oligometastatic prostate cancer (OMPC) is increasing, and various clinical studies have reported the benefits of metastasis-directed radiation therapy (MDRT) in OMPC. However, the recognition regarding the adopted definitions, methodologies of assessment, and therapeutic approaches is diverse among radiation oncologists. This study aims to evaluate the level of agreement for issues in OMPC among radiation oncologists.
METHODS: We generated 15 key questions (KQs) for OMPC relevant to definition, diagnosis, local therapies, and endpoints. Additionally, three clinical scenarios representing synchronous metastatic prostate cancer (mPC) (case 1), metachronous mPC with visceral metastasis (case 2), and metachronous mPC with castration-resistance and history of polymetastasis (case 3) were developed. The 15 KQs were adapted according to each scenario and transformed into 23 questions with 6-9 per scenario. The survey was distributed to 80 radiation oncologists throughout the Republic of Korea. Answer options with 0.0-29.9%, 30-49.9%, 50-69.9%, 70-79.9%, 80-89.9%, and 90-100% agreements were considered as no, minimal, weak, moderate, strong, and near perfect agreement, respectively.
RESULTS: Forty-five candidates voluntarily participated in this study. Among 23 questions, near perfect (n = 4), strong (n = 3), or moderate (n = 2) agreements were shown in nine. For the case recognized as OMPC with agreements of 93% (case 1), near perfect agreements on the application of definitive radiation therapy (RT) for whole metastatic lesions were achieved. While ≥70% agreements regarding optimal dose-fractionation for metastasis-directed RT (MDRT) has not been achieved, stereotactic body RT (SBRT) is favored by clinicians with higher clinical volume.
CONCLUSIONS: For the case recognized as OMPC, near perfect agreement for the application of definitive RT for whole metastatic lesions was reached. SBRT was more favored as a MDRT by clinicians with a higher clinical volume.