onc brain

Systematic review (183 articles) plus 3-round modified Delphi, May 2025 to Feb 2026. Consensus = ≥75% agreement; independent peer review, endorsed by ASTRO and ESTRO.

Panel of 48 experts from 15 countries: 34 radiation oncologists, 7 medical oncologists, 7 urologic oncologists across North America, Europe, Asia and Australia. Scope: acute medical mgmt, RT technique, outlet obstruction, urology referral, HBOT.

76% favored moderate hypofx over SBRT at baseline IPSS 15–19; 85% endorsed a full bladder at sim and treatment. No specific dose-volume constraint reached consensus.

Intact prostate: alpha blockers first for obstructive, anti-spasmodics first for irritative symptoms; post-RP: anti-spasmodics first. 80% against prophylactic medication; 80% add a 2nd agent rather than switch.

MIRAGE was cited for margin reduction (late G≥2 GU 51% → 27% with 2-mm MRI-guided vs 4-mm CT-guided). CHHiP, PROFIT, RTOG 0415 and HYDRA were cited as showing no consistent late GU excess with moderate hypofx; RICH-ART supports HBOT for radiation cystitis.

Several reported positions (74% IPSS ≥20 referral, 66% ≥12-wk wait, 52% SBRT after outlet procedure) fall below the ≥75% consensus bar. Panel is radonc-weighted, and this read comes from a conference summary, not the full manuscript.

Formalizes IPSS as a fractionation and referral gate and standardizes symptom-directed pharmacotherapy. It leaves dose-volume constraints, urethral contouring reliability and RT-specific drug evidence open; BEFORE, RadTARGET, RELIEF and DESTINATION-2 are named as ongoing.

Delphi consensus over a systematic review; agreement figures are opinion, not outcomes. First RT-specific GU toxicity framework, with core technique questions left unresolved.

Clinical practice guideline, not a trial. Systematic review of Ovid MEDLINE and Embase, January 2009 to November 18, 2024, yielding 153 studies; retrospective series limited to ≥65 pts (KQ1) and ≥100 pts (KQ2). Consensus by modified Delphi, threshold ≥75% agreement (≥90% for expert-opinion recs).

Adults (≥18 years) with bladder cancer treated with RT, across 4 KQs: bladder preservation, intact-bladder technique and dose, postoperative RT, noncurative RT. Out of scope: surgical management of MIBC, systemic-therapy specifics, intravesical therapy.

Preferred concurrent radiosensitizers: cisplatin ± 5-FU, 5-FU + mitomycin-C, or low-dose gemcitabine; carbogen and nicotinamide an alternative. Capecitabine ± mitomycin-C or single-agent 5-FU for pts ineligible for those agents.

Simulation and daily treatment supine with empty bladder and rectum; fiducials help delineate a tumor boost. 2 to 4 weeks from maximal TURBT to RT is typical, and post-TMT cystoscopy with biopsy follows at 8 to 12 weeks.

Caution, not absolute contraindication, for active inflammatory bowel disease, prior pelvic RT, or severely reduced bladder capacity. Elective nodal coverage is weighed against bowel toxicity.

Prior RTOG and NRG studies put the prostate in the field under 3-D CRT; the guideline narrows that to base/neck, T4 or prostatic urethral involvement. SWOG/NRG 1806 allowed bladder-only or bladder plus pelvic nodes, which the task force reads as equipoise on elective nodal coverage. Bladder-only series report ~7% pelvic nodal recurrence.

Search closed November 18, 2024 and excluded abstract-only reports. Histology guidance rests mostly on pure urothelial data, and ctDNA after TMT is not yet prospectively validated.

TMT is framed as curative treatment alongside RC within multidisciplinary shared decision-making, not a fallback for unfit pts. The guideline names access as the binding constraint: Black pts with MIBC are less likely to receive curative-intent cystectomy or chemoRT.

ASTRO guideline from systematic review (153 studies) plus modified Delphi; output is graded recommendations, not outcomes. Elective nodal RT and adjuvant RT stay conditional.

Modified Delphi consensus, 20 North American multidisciplinary experts, iterative discussion and voting over two rounds. Followed by a 29-case pilot concordance exercise against external experts.

Framework spans the full HCC spectrum, from unifocal ≤3 cm (Class 1A) to distant metastases (Class 4B). Class assignment keys on tumor burden, Vp level of portal invasion, and poor prognostic features (>8 cm, AFP >1000 ng/mL, poor differentiation).

EBRT including SBRT is named a first-line locoregional option in Classes 1A through 3A, on par with TARE, RFA/MWA, and TACE. No dose or fractionation is specified anywhere in the framework: the stated rationale is ablative dose delivered selectively to limit radiation-induced liver injury. In Class 4A, EBRT is not routinely indicated outside palliation of symptomatic disease.

Expert decisions matched BEACON in 28 of 29 cases (96.6%) vs 72.4% for BCLC 2025. The single discordant case was combination systemic plus locoregional therapy for vascular invasion reaching the right atrium.

BCLC keeps radiation outside its core allocation algorithm; BEACON moves it in. The supporting evidence the panel cites is uneven: DOSISPHERE (ORR 71 vs 36%, OS 26.6 vs 10.7 mo) for personalized-dosimetry TARE is randomised, while the SBRT case in Class 3B rests on RTOG1112, which reached only p=0.06 for OS vs sorafenib.

The 72.4% BCLC comparator was scored by BEACON's own authors against cases the same group selected, and 29 cases cannot exercise nine classes evenly. Round-1 per-class agreement is unreadable from the source table because vote counts and class labels arrived unpaired.

The framework's real claim is that intrahepatic burden and Vp level, not BCLC's stage buckets, should drive allocation, and that radiation-based modalities are burden-appropriate rather than stage-restricted. Whether that improves outcomes is untested: validation against empiric clinical data is deferred to the HCC-Live Consortium.

Delphi consensus framework, not an efficacy study. Concordance figures measure opinion against opinion. Elevates EBRT/TARE to first-line locoregional status in a formal allocation system.

Contouring consensus: 16 IROCK radiation oncologists contoured 4 CT-only cases; a STAPLE algorithm produced the 95% consensus contour, refined over 2 online meetings (May and June 2024) until 100% agreement on statements.

Panel eligibility: ≥10 RCC SABR cases treated; 14 of 16 had treated ≥10 pts in the prior 12 months. Cases: >10 cm tumor with IVC thrombus, central tumor at the hilum, post-nephrectomy recurrence, post-RFA residual.

iGTV equals ITV since no microscopic-spread margin is added. Most common PTV: uniform 5 mm on iGTV with supine vacuum cushion, 4DCT, IV contrast and daily CBCT. Participants used 1, 3, or 5 fractions; OAR constraints drawn from FASTRACK-II and AQuOS-II protocols.

Overall median DSC 0.85 (range 0.40-0.95), MDA 2.17 mm, HD 9.00 mm; median DSC >0.70 in every case. Greatest variation in Case 1 (superior thrombus extent) and Case 4 (cavity inclusion).

FASTRACK-II established prospective phase II support for RCC SABR; this document standardizes the target and OAR definitions that trial-era protocols left variable. AQuOS-II is prospectively testing whether ipsilateral parenchyma and hilum contours matter for toxicity.

CT-only images; MRI might have reduced variation. Participants did not recontour after consensus, so the post-consensus agreement is assumed rather than measured.

The guideline chooses OAR priority over coverage and accepts heterogeneous target dose, which trades some target coverage for bowel safety. Whether hilum or cortex sparing reduces renal toxicity remains unanswered and is deliberately left optional.

Expert contouring consensus; agreement metrics measure contour overlap, not outcome. Standardizes target definition for an emerging indication; not validated prospectively.

Three-round Delphi. 57 statements drafted after literature review across epidemiology-pathophysiology (n=8), causes (n=10), imaging (n=10), histopathology (n=9), management (n=20), plus an exploratory research set of 8. Consensus prespecified at ≥80% agreement on a 5-point Likert scale.

The voting panel, not patients: 15 volunteers (2 radiation/clinical oncologists, 4 neuro-oncologists, 4 medical oncologists, 2 neurosurgeons, 1 neuropathologist, 1 neuroradiologist, 1 nuclear medicine physician), expanded by 5 more in round 1 (4 neuro-oncologists, 1 radiation/clinical oncologist) to 20 total. Clinically the scope is RN after RT for primary glial or metastatic brain tumors.

RN is called uncommon below EQD2 ~40 Gy (α/β 2 Gy), rising with dose per fraction, total dose and irradiated volume. V12Gy ~10 cm³ carries a 5-10% symptomatic necrosis risk after single-session SRS; for hypofractionated SRT, brain-plus-target V20Gy (3fx) or V24Gy (5fx) <20 cm³ associates with <10% any necrosis and <4% RN requiring resection. Re-irradiation risk stays under 10% at cumulative EQD2 100-110 Gy and reaches up to 25% above 130 Gy.

Consensus reached on 53 of 57 statements after three rounds. Diagnostic and management statements are tabulated separately in the details; the four that failed to reach 80% are not identified in the available text.

The document's practical contribution is a decision sequence rather than a new treatment: advanced MRI first, amino acid PET to add confidence, tissue when doubt persists, and treatment triggered only by symptoms of >7 days with increasing severity. Its most consequential position is moving bevacizumab from rescue to an expected next step at a defined steroid threshold (dependence >4 weeks or dexamethasone 8 mg/day), which is a lower bar than many centres apply.

Agreement percentages measure how a self-selected 20-person European panel voted, and the panel skews neuro-oncology (8 of 20) over radiation oncology (3 of 20) for a complication defined by dose and volume. FET and F-DOPA availability is largely European, so the imaging algorithm's top tier is not reproducible in most centres worldwide. The 4 non-consensus statements are not enumerated in the accessible text, so the reader cannot see where the panel actually split.

Delphi expert-opinion document, no efficacy endpoint. Agreement measured against opinion, not outcomes; authors state absence of Level 1 evidence and call for randomised trials.

ESTRO-convened multi-disciplinary expert group developing delineation guidelines through discussion and review of current evidence and international practice. Drafts were reviewed by HNSCC experts from countries outside the authorship (Japan, Hong Kong, Australia, Brazil, Mexico, Canada, Denmark, France, Spain, Poland, Ireland, UK) and modified on their feedback. No efficacy endpoint, no patient cohort.

Patients with oral cavity squamous cell carcinoma requiring post-operative radiotherapy, regardless of margin status and other histological risk factors. R2 resection (macroscopic residual disease) is explicitly out of scope. Companion background manuscript from the same group covers indications for PORT.

Planning CT 2.0 mm slices (range 1-3 mm), skull base to below sterno-clavicular joint, IV contrast mandatory, rigid co-registration with pre-op contrast-enhanced CT and/or MRI matched to C1-C3 vertebral bodies or nearby bone, not to soft tissue. CTV-P is the composite of GTV-P pre-op + 10 mm and surgical defect/flap + 5 mm, edited for bone, fascia, air, teeth and any intra-oral prosthesis. Nodal margin is 5 mm on GTV-N pre-op without pENE, 10 mm with pENE.

None. The stated aim is consistency of delineation to enable multi-institutional audit, clinical trials and RTQA. Authors position prospective audits of practice and outcomes as the route to establishing these volumes as standard of care.

Extends the 2018 international CTV-P consensus for definitive HNSCC RT, whose 5+5 mm geometric expansion supplies the 10 mm used here around GTV-P pre-op. Cites the DAHANCA finding that geometric expansion is more conformal than anatomical margins, a post-hoc De-ESCALaTE analysis correlating the anatomical-to-geometric protocol change with lower late dysphagia, and non-randomised Dutch series where reducing the high-risk margin 10 mm to 6 mm cut salivary and constrictor dose. GORTEC's 2020 flap delineation guidance is named as an adjunct.

The 5 mm and 10 mm margins are imported from definitive-setting geometry and one surgical pathology series (>95 % of microscopic infiltration within 5 mm of GTV-P edge), not from post-operative recurrence mapping. The dose to dissected but uninvolved levels rests on a 1993 MD Anderson observation never tested prospectively, and is left to clinician discretion (EQD2 50-60 Gy). The whole method assumes accurate pre-op to planning CT co-registration, and the fallback where it fails is to treat the entire involved level, a larger volume.

The novel move is refusing to pick between the two available surrogates for a resected tumour: re-created pre-op GTV and operative bed are contoured independently and unioned, because each fails in a different direction. Fig 3.1 shows a GTV-P pre-op extending superiorly past the defect toward the infratemporal fossa, and Fig 8.1 a pectoralis major pedicled flap whose composite volume extends outside the oral cavity and is trimmed back. What is left unsettled is dose de-escalation to central flap tissue, where the guideline offers a flap avoidance structure for standardisation while stating there is a lack of data and consequently a lack of consensus.

ESTRO expert guideline, no efficacy endpoint. Fills a documented gap (no prior post-op HNSCC CTV consensus); authors themselves position prospective audit as the validation step.

PRISMA systematic review of PubMed and Embase (searched 28 June 2022) across four topics, excluding conference abstracts, non-English publications and series of fewer than five patients. A 12-member multidisciplinary panel of radiation oncologists, urologists and medical oncologists voted in two rounds by modified Delphi, with RAND methodology defining disagreement.

Scope is tier A disease, local-only intraprostatic radiorecurrence after definitive RT, with BCR defined as PSA 2.0 ng/ml above nadir. Evidence was restricted to men whose primary treatment was conventionally fractionated EBRT, and prior brachytherapy patients were excluded from the synthesis. Every variant presumes the patient wants curative-intent local salvage.

All accepted salvage schemas fit in six or fewer fractions. For focal salvage, GETUG-AFU 31 defines GTV by mpMRI plus choline PET with a 5-7 mm margin bound by the prostatic capsule; whole-gland salvage SBRT has prospective support from the Fuller series. Dose constraints and IGRT method are out of scope.

Long hormone courses are recommended against across all salvage scenarios. A short 4-6 mo LHRH agonist carries moderate consensus as a radiosensitizer with salvage SBRT in patients without cardiac history, weaker consensus with cardiac comorbidity, and classic ADT is preferred over novel hormonal agents.

The toxicity read that drives the reirradiation preference comes from pooled retrospective data that could not evaluate sexual toxicity and included no PSMA PET selection. Approaches that combine biopsy and ablation in one procedure are discouraged, since histologic confirmation must precede salvage.

No prior consensus guideline addressed intraprostatic radiorecurrence exclusively. The hormone-only comparators being displaced (Crook intermittent vs continuous ADT, TOAD immediate vs delayed, EMBARK enzalutamide MFS benefit) all enrolled before PET-based selection and none isolated a biopsy-confirmed, local-only cohort. RTOG 0526 reported after MASTER closed, adding prospective LDR support.

The search closed 28 June 2022 with an acknowledged lag to publication. MASTER carries between-study heterogeneity and follow-up asymmetry favoring older modalities, so its flat efficacy comparison is not a randomised one. The hormone recommendation rests on no qualifying study and is extrapolated from de novo intermediate-risk data.

Settled: image, biopsy with both systematic and targeted cores, then prefer reirradiation over hormones alone. Not settled: the modality for a second salvage, for castrate-resistant local recurrence, for short PSA doubling time, or after prior grade 3 toxicity, all of which drew panel disagreement.

Appropriate use criteria from a 12-member Delphi panel; the output is a recommendation grid, not an efficacy result. No trial endpoint, so efficacy verdicts do not apply.