International Consensus Guidelines on the Delineation of Radiation Therapy Target Volumes for Nasopharyngeal Carcinoma After Induction Chemotherapy Using a 2-Round Modified Delphi Survey.

IF 3.4 3区 医学 Q2 ONCOLOGY
Nejla Fourati, Warren Bacorro, Omar Nouri, Ryan Anthony Agas, Audrey Larnaudie, Lester Bryan Co, Hela Hammami, Clevelinda Calma, Melvin L K Chua, Chong Zhao, Jamel Daoud, Michael Benedict Mejia
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引用次数: 0

Abstract

Purpose: Induction chemotherapy (ICT), a new standard in the management of locally advanced nasopharyngeal carcinoma (NPC), is increasingly used in endemic regions. Radiation therapy (RT) target volume delineation protocols and dose level prescriptions vary significantly in the literature. High-level evidence to support a particular approach is currently lacking. We developed an international consensus guideline toward harmonizing practices based on a literature review and expert opinion.

Methods and materials: The study entailed the following: consensus scope definition by focus group discussion (FGD); evidence gap identification by a scoping review of guidelines and literature reviews; evidence review and synthesis by a systematic review of experimental and observational studies and drafting of consensus statements by FGD; and consensus voting by modified Delphi process and FGD. The task force consisted of radiation oncologists from intermediate- and high-endemicity regions with expertise in treating NPC, evidence review, and consensus guideline development. The consensus panel consisted of relevant specialists from intermediate- and high-endemicity regions or with expertise in treating NPC. A modified e-Delphi method was used.

Results: Four clinical situations after ICT for patients with NPC were selected for the consensus questions: optimal timing of chemoradiation; optimal imaging modalities for simulation and target volume delineation; optimal dose and fractionation; and RT target volume delineation. The consensus panel consisted of radiation oncologists (12), clinical oncologists (4), radiologists (3), a nuclear medicine specialist, medical physicists (2), and dosimetrists (2). The consensus guidelines were formulated after 2 rounds of Delphi voting and FGD; iterative revisions were made based on 2 rounds of internal review. The guidelines were subjected to external review and open commentary; further revisions were made if the consensus vote was not invalidated.

Conclusions: An international consensus guideline on delineating RT target volumes and corresponding dose levels in post-ICT NPC, as well as timing and modalities for imaging, was developed to help harmonize practices and enhance the comparability of interpretations of reported outcomes.

使用2轮修正德尔菲调查划定鼻咽癌诱导化疗后放射治疗靶体积的国际共识指南。
目的:诱导化疗作为局部晚期鼻咽癌(NPC)治疗的新标准,在鼻咽癌流行地区得到越来越多的应用。放射治疗(RT)靶体积划定方案和剂量水平处方在文献中差异很大。目前缺乏支持某一特定方法的高水平证据。我们在文献综述和专家意见的基础上制定了一项国际共识指导方针,以协调实践。方法和材料:该研究包括以下内容:通过焦点小组讨论(FGD)达成共识的范围定义;通过指南和文献综述的范围审查来确定证据差距;通过对实验和观察性研究的系统审查来审查和综合证据,并由FGD起草共识声明;采用改进的德尔菲法和FGD法进行共识投票。该工作组由来自中高流行地区的放射肿瘤学家组成,他们具有治疗鼻咽癌、证据审查和共识指南制定方面的专业知识。协商一致的专家组由来自中高流行地区或具有治疗鼻咽癌专业知识的相关专家组成。采用改进的e-Delphi法。结果:选择鼻咽癌患者行ICT后的4种临床情况作为共识问题:最佳放化疗时机;模拟和目标体积描绘的最佳成像模式;最佳剂量和分级;RT靶体积圈定。共识小组由放射肿瘤学家(12名)、临床肿瘤学家(4名)、放射学家(3名)、核医学专家、医学物理学家(2名)和剂量测定师(2名)组成。共识指南是经过两轮德尔菲投票和FGD后制定的;在2轮内部评审的基础上进行了迭代修订。这些准则接受了外部审查和公开评论;如果协商一致投票没有无效,则进一步修订。结论:制定了一项关于描述ict后鼻咽癌RT靶体积和相应剂量水平以及成像时间和方式的国际共识指南,以帮助协调实践并增强对报告结果解释的可比性。
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来源期刊
Practical Radiation Oncology
Practical Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
5.20
自引率
6.10%
发文量
177
审稿时长
34 days
期刊介绍: The overarching mission of Practical Radiation Oncology is to improve the quality of radiation oncology practice. PRO''s purpose is to document the state of current practice, providing background for those in training and continuing education for practitioners, through discussion and illustration of new techniques, evaluation of current practices, and publication of case reports. PRO strives to provide its readers content that emphasizes knowledge "with a purpose." The content of PRO includes: Original articles focusing on patient safety, quality measurement, or quality improvement initiatives Original articles focusing on imaging, contouring, target delineation, simulation, treatment planning, immobilization, organ motion, and other practical issues ASTRO guidelines, position papers, and consensus statements Essays that highlight enriching personal experiences in caring for cancer patients and their families.
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