onc brain

Joint ESGO/ESTRO/ESP guideline updating the 2014 European consensus. MEDLINE review of Jan 2014 to June 2019; recommendations graded on an adapted IDSA-USPHS scale (levels I-V, grades A-E), with 191 external reviewers and patient input.

Universal MMR IHC or MSI in all EC regardless of histology (III, B), with MLH1 promoter methylation testing when MLH1/PMS2 is lost. Lynch surveillance generally from age 35 and risk-reducing hysterectomy + BSO preferably before 40 (IV, B).

The molecular surrogate algorithm (p53, MSH6, PMS2, POLE) is endorsed only as a complete panel, because ~5% of tumors are multiple classifiers. POLEmut status requires a pathogenic variant in the exonuclease domain.

Literature search stopped at June 2019 and was English-only. The captured excerpt ends before the adjuvant therapy section, so RT and systemic recommendations are not reported in source text.

ABS Gynecologic Cancer Task Force compendium (Brachytherapy 2019). Experts reviewed the literature, the existing ABS guidelines and their own clinical experience, then reached consensus over conference calls. Not a systematic review.

All schemes are given as EQD210 for tumor and EQD23 for OAR, so regimens can be summed and compared. Cervix image-guided target: HR-CTV D90 85-95 Gy EQD210, starting from the Point A schedules and then optimized. Interstitial needle loading should hold no more than 10-20% of total dwell time.

The cervix target range and the tighter OAR limits (rectal D2cc ≤65 Gy, bladder ≤80 Gy) come from EMBRACE, not the older ABS 2012 Point A guidance. For the cuff, Portec-2 and institutional series supply the schedules, and Sorbe is the only randomized comparison of fractionation.

Several of the source tables could not be reliably paired row-to-value here, so specific scheme-to-EQD2 mappings for Point A, interstitial and inoperable uterine schedules are not reproduced. The cervix Point A schedules derive from 2012 ABS guidance and are pre-optimization starting points.

The document is a reference list of what is acceptable, not a ranking. Its practical value is the EQD2 bookkeeping and the explicit caution on >7 Gy/fx. It leaves open which cuff scheme is best and how to load newer free-trajectory interstitial applicators.

Case-based practical guide endorsed by the Radiosurgery Society, built on two modified real-world cases. Expert synthesis of existing evidence, not a trial or systematic review.

Both cases 40 Gy in 5 fractions to prostate + proximal SV; Case B added an MR-guided SIB of 42 Gy to the dominant intraprostatic lesion. Case A prescribed to the 100% isodose covering PTV, limiting V105% (42 Gy) < 20-30%, with hydrogel spacer and QOD delivery.

Large prostate is not a contraindication if OAR constraints are met; spacer and bladder filling help, and neoadjuvant ADT purely for cytoreduction is discouraged. Pts with baseline IPSS ≥15 had low G3 GU toxicity with prophylactic α1-antagonists but should be counselled on a harder transient flare.

PACE-B is the reference trial but enrolled few large glands (5% ≥80 mL) and allowed prior TURP. MIRAGE (NCT04384770) is cited for MR guidance reducing toxicity.

Case A's own neoadjuvant ADT shrank the gland from 112 to 61 mL, so it does not test SBRT on an untreated large gland. Whether large-gland GU risk is specific to SBRT fractionation remains unresolved pending PACE-B subgroup analyses.

ESTRO ACROP Delphi consensus, 40-item questionnaire in 3 rounds (Jul 22 to Dec 16, 2019). Items with >80% agreement were retired as consensus; an EAU-nominated urologist sat on the reviewing committee.

Panel of 18 of 33 invited authors of salvage SBRT papers (54.5%), all completing every round. 12/18 work in centres treating >2,000 pts/yr; only 2 practise outside Europe.

Consensus on a focal CTV (mpMRI GTV + adaptive margin), dose prescribed to the isodose, and no concomitant ADT. Schedules in use were 5-6 fx up to about 35 Gy, but the panel did not agree on a recommended fractionation or on dose relative to the primary course.

14/40 items reached consensus (35%), half of them in round 1; consensus or major agreement on 27/40 (68%). Agreement was highest for imaging/staging (W 0.34) and lowest for dosimetry (W 0.12).

The Uro-GEC-ESTRO salvage brachytherapy Delphi split on whole-gland vs focal targets and mandated histology; this panel agreed on focal GTV-based CTV but split on biopsy. The Italian AIRO PROLAPSE survey leaned toward concurrent ADT, which this panel rejected.

Rounds closed before most PSMA-PET data appeared, so the 28% PSMA-PET endorsement is dated. Panellists were selected as authors of the mostly retrospective, short-follow-up series the consensus draws on, which risks circular endorsement.

The unresolved items (biopsy, dose, cumulative OAR constraints) are the ones a prospective protocol has to fix first. The ongoing trials cited already disagree with each other on interval (2 vs 4 yr) and on whole-gland vs partial CTV.

ASCO expert panel with ASTRO, AUA, SNMMI, ACR, SAR and SUO. Systematic review 2013 to Aug 2018, 35 studies: 17 systematic reviews ± meta-analysis and 18 primary articles.

Men with advanced prostate cancer: newly diagnosed clinical high-risk, suspected or confirmed metastatic, recurrent, or progressive on treatment, including nonmetastatic CRPC and metastatic CRPC.

For men in whom salvage radiotherapy is contemplated, NGI should be offered (Rec 4.4; evidence high, strength strong). Habl et al reported 59% RT plan changes from 68Ga-PSMA PET/CT.

Conventional imaging (CT, bone scan, prostate MRI) and/or NGI per scenario. NGI is not offered absent salvage intent after RP (4.3) or RT (4.5), and not routinely offered for radiographic progression in mCRPC (4.11).

Evidence is drawn from detection-rate and diagnostic-accuracy meta-analyses of choline, fluciclovine, acetate and 68Ga-PSMA PET. It contains no randomized trial of NGI-guided treatment with clinical outcome endpoints.

Literature closes Aug 2018, before the prospective PSMA PET era matured. Much of the recommendation set is informal consensus with benefits/harms ratio uncertain.

The guideline makes imaging conditional on a salvage or care-change decision, not a reflex to rising PSA. It does not settle whether NGI-driven stage migration improves outcomes, especially for oligometastatic MDT selection (4.7).