Περίληψη:
Simple Summary There are various society-specific guidelines addressing
adjuvant brachytherapy (BT) after surgery for endometrial cancer (EC).
However, these recommendations are not uniform. Against this background,
clinicians need to make decisions despite gaps between best scientific
evidence and clinical practice. We analysed decision criteria
influencing the selection for adjuvant radiotherapy among European
radiation oncology experts. For this, GEC-ESTRO provided 19 European
radiation oncology experts on gynaecological brachytherapy for
decision-making analyses. The manuscript presents patterns in
decision-making among these experts and demonstrates areas of
consensus/discrepancies. We also analysed dose prescription and
techniques of brachytherapy. This analysis is of special value as the
objective approach enabled us to obtain an unbiased description of
decision-making among the specialists (the study was not aimed to create
or enforce a consensus). The manuscript provides valuable insight into
clinical decision-making with a high impact on treatment selection, as
expected differences between experts were observed. With this manuscript
we are able to visualize and quantify these. This information is
relevant for interdisciplinary discussions. Background: There are
various society-specific guidelines addressing adjuvant brachytherapy
(BT) after surgery for endometrial cancer (EC). However, these
recommendations are not uniform. Against this background, clinicians
need to make decisions despite gaps between best scientific evidence and
clinical practice. We explored factors influencing decision-making for
adjuvant BT in clinical routine among experienced European radiation
oncologists in the field of gynaecological radiotherapy (RT). We also
investigated the dose and technique of BT. Methods: Nineteen European
experts for gynaecological BT selected by the Groupe Europeen de
Curietherapie and the European Society for Radiotherapy & Oncology
provided their decision criteria and technique for postoperative RT in
EC. The decision criteria were captured and converted into decision
trees, and consensus and dissent were evaluated based on the objective
consensus methodology. Results: The decision criteria used by the
experts were tumour extension, grading, nodal status, lymphovascular
invasion, and cervical stroma/vaginal invasion (yes/no). No expert
recommended adjuvant BT for pT1a G1-2 EC without substantial LVSI.
Eighty-four percent of experts recommended BT for pT1a G3 EC without
substantial LVSI. Up to 74% of experts used adjuvant BT for pT1b
LVSI-negative and pT2 G1-2 LVSI-negative disease. For 74-84% of
experts, EBRT + BT was the treatment of choice for nodal-positive pT2
disease and for pT3 EC with cervical/vaginal invasion. For all other
tumour stages, there was no clear consensus for adjuvant treatment. Four
experts already used molecular markers for decision-making. Sixty-five
percent of experts recommended fractionation regimens of 3 x 7 Gy or 4 x
5 Gy for BT as monotherapy and 2 x 5 Gy for combination with EBRT. The
most commonly used applicator for BT was a vaginal cylinder; 82%
recommended image-guided BT. Conclusions: There was a clear trend
towards adjuvant BT for stage IA G3, stage IB, and stage II G1-2
LVSI-negative EC. Likewise, there was a non-uniform pattern for BT dose
prescription but a clear trend towards 3D image-based BT. Finally,
molecular characteristics were already used in daily decision-making by
some experts under the pretext that upcoming trials will bring more
clarity to this topic.
Συγγραφείς:
Glatzer, Markus
Tanderup, Kari
Rovirosa, Angeles
Fokdal,
Lars
Ordeanu, Claudia
Tagliaferri, Luca
Chargari, Cyrus and
Strnad, Vratislav
Dimopoulos, Johannes Athanasios
Segedin,
Barbara
Cooper, Rachel
Nakken, Esten Sondrol
Petric, Primoz
and van der Steen-banasik, Elzbieta
Lossl, Kristina and
Juergenliemk-Schulz, Ina M.
Niehoff, Peter
Hermansson, Ruth S.
and Nout, Remi A.
Putora, Paul Martin
Plasswilm, Ludwig and
Tselis, Nikolaos
