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. 2024 Sep;200(9):737-750.
doi: 10.1007/s00066-024-02254-2. Epub 2024 Jul 12.

Dose prescription for stereotactic body radiotherapy: general and organ-specific consensus statement from the DEGRO/DGMP Working Group Stereotactic Radiotherapy and Radiosurgery

Thomas B Brunner  1   2 , Judit Boda-Heggemann  3 , Daniel Bürgy  3 , Stefanie Corradini  4 , Ute Karin Dieckmann  5 , Ahmed Gawish  6 , Sabine Gerum  7 , Eleni Gkika  8 , Maximilian Grohmann  9 , Juliane Hörner-Rieber  10 , Simon Kirste  11 , Rainer J Klement  12 , Christos Moustakis  13 , Ursula Nestle  14 , Maximilian Niyazi  15 , Alexander Rühle  13 , Stephanie-Tanadini Lang  16 , Peter Winkler  5   17 , Brigitte Zurl  17 , Andrea Wittig-Sauerwein  18 , Oliver Blanck  19
Affiliations

Dose prescription for stereotactic body radiotherapy: general and organ-specific consensus statement from the DEGRO/DGMP Working Group Stereotactic Radiotherapy and Radiosurgery

Thomas B Brunner et al. Strahlenther Onkol. 2024 Sep.

Abstract

Purpose and 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.

Materials and 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.

Conclusion: 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.

Keywords: Consensus; Dose prescription; ICRU report 91; Radiation oncology; Stereotactic body radiotherapy.

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Conflict of interest statement

TB: AstraZeneca (speaker), Onconovum (speaker), Heckel (research support), Brainlab (research support), Varian (educational); JBH: EBAMed SA (Consultant), Elekta (Research), AstraZeneca (Education / Meeting Faculty); DB: Siemens AG (speaker), NB Capital Research GmbH (speaker), NB Capital ApS (speaker), PharmaMar GmbH (speaker); (SC): Elekta, (speakers bureau), Brainlab (research); UN: (AstraZeneca, research) MN: (Brainlab (speaker, research), Astrazeneca (speaker)) BZ: (EBG MedAustron GmbH (Advisory Board), Elsevier (Advisory Board)); AR: Novocure (speaker), Merck (speaker). Ute Karin Dieckmann, Ahmed Gawish, Sabine Gerum, Eleni Gkika, Maximilian Grohmann, Juliane Hörner-Rieber, Simon Kirste, Rainer J. Klement, Christos Moustakis, Stephanie-Tanadini Lang, Peter Winkler, Andrea Wittig-Sauerwein, and Oliver Blanck declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Percentage of agreement in the second round of the Delphi process for each of the statements with the options to vote yes, no, or not qualified. Not qualified describes statements for which either physicians or physicists did not rank the statement to be part of their expertise. a Agreement rates for overarching statements; b agreement rates for organ-specific statements
See this image and copyright information in PMC

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