onc brain

Systematic review (183 articles) plus 3-round modified Delphi, May 2025 to February 2026. 48 experts from 15 countries: 34 radiation oncologists, 7 medical oncologists, 7 urologic oncologists. Consensus = ≥75% agreement; independently peer reviewed, endorsed by ASTRO and ESTRO.

Men with GU adverse events associated with prostate cancer RT, split by intact prostate vs postoperative and, when intact, obstructive vs irritative predominance. Five domains: acute medical management, RT technique, bladder outlet obstruction, urology referral indications, hyperbaric oxygen. Recommendations assume UTI has been excluded.

76% favored moderate hypofractionation over SBRT at baseline IPSS 15–19; 85% recommended a full bladder at simulation and treatment. After a bladder outlet procedure, 94% would wait ≥8 weeks and 66% ≥12 weeks before RT; only 52% considered SBRT safe afterward. No dose-volume constraint reached consensus.

Agreement figures and IPSS threshold distributions are tabulated in the bullets. The manuscript reports consensus on 31 key questions; the source covers a subset.

The presenter cited MIRAGE for margin reduction (2-mm MRI-guided vs 4-mm CT-guided, late G≥2 GU 51% → 27%) and CHHiP, PROFIT, RTOG 0415 and the HYDRA meta-analysis as showing no consistent late GU increase with moderate hypofractionation. RICH-ART was cited as randomized support for hyperbaric oxygen in late radiation cystitis; no effect size reported in source.

Several quoted positions fall below the group's own ≥75% bar (74%, 74%, 66%, 52%). The source gives 60% for IPSS ≥15 and 61% for the 15–19 band without reconciling them. Outlet-procedure questions were voted by a panel with 34 radiation oncologists and 7 urologic oncologists.

A default sequence for symptom management and an IPSS-anchored fractionation preference now exist where practice was improvised. Still unsettled, per the working group: dose-volume constraints, reliability of urethral contouring, and RT-specific evidence for commonly used medications. Four ongoing trials are named (BEFORE, RadTARGET, RELIEF, DESTINATION-2) and the document is intended to be living.

Modified Delphi guideline; every percentage is panel opinion, not an outcome. Changes practice by standardizing GU symptom management and IPSS-based fractionation choice where no RT-specific guideline existed.

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.