Salvage prostate brachytherapy in radiorecurrent prostate cancer: An international Delphi consensus study

Mark T. Corkum; Mark K. Buyyounouski; Albert J. Chang; Hans T. Chung; Peter Chung; Brett W. Cox; Juanita M. Crook; Brian J. Davis; Steven J. Frank; Ivan Henriquez; Eric M. Horwitz; Peter Hoskin; I-Chow Hsu; Mira Keyes; Martin T. King; Marisa A. Kollmeier; Daniel J. Krauss; Andrzej M. Kukielka; Gerard Morton; Peter F. Orio III; Bradley R. Pieters; Louis Potters; Peter J. Rossi; Timothy N. Showalter; Abhishek A. Solanki; Daniel Song; Ben Vanneste; Eric Vigneault; Piotr A. Wojcieszek; Michael J. Zelefsky; Mitchell Kamrava

doi:10.1016/j.radonc.2023.109672

Salvage prostate brachytherapy in radiorecurrent prostate cancer: An international Delphi consensus study

Mark T. Corkum^*, Mark K. Buyyounouski, Albert J. Chang, Hans T. Chung, Peter Chung, Brett W. Cox, Juanita M. Crook, Brian J. Davis, Steven J. Frank, Ivan Henriquez, Eric M. Horwitz, Peter Hoskin, I-Chow Hsu, Mira Keyes, Martin T. King, Marisa A. Kollmeier, Daniel J. Krauss, Andrzej M. Kukielka, Gerard Morton, Peter F. Orio IIIBradley R. Pieters, Louis Potters, Peter J. Rossi, Timothy N. Showalter, Abhishek A. Solanki, Daniel Song, Ben Vanneste, Eric Vigneault, Piotr A. Wojcieszek, Michael J. Zelefsky, Mitchell Kamrava

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background and Purpose: Local recurrences after previous radiotherapy (RT) are increasingly being iden-tified in biochemically recurrent prostate cancer. Salvage prostate brachytherapy (BT) is an effective and well tolerated treatment option. We sought to generate international consensus statements on the use and preferred technical considerations for salvage prostate BT.Materials and Methods: International experts in salvage prostate BT were invited (n = 34) to participate. A three-round modified Delphi technique was utilized, with questions focused on patient-and cancer -specific criteria, type and technique of BT, and follow-up. An a priori threshold for consensus of >= 75% was set, with a majority opinion being >= 50%.Results: Thirty international experts agreed to participate. Consensus was achieved for 56% (18/32) of statements. Consensus was achieved in several areas of patient selection: 1) A minimum of 2-3 years from initial RT to salvage BT; 2) MRI and PSMA PET should be obtained; and 3) Both targeted and system-atic biopsies should be performed. Several areas did not reach consensus: 1) Maximum T stage/PSA at time of salvage; 2) Utilization/duration of ADT; 3) Appropriateness of combining local salvage with SABR for oligometastatic disease and 4) Repeating a second course of salvage BT. A majority opinion pre-ferred High Dose-Rate salvage BT, and indicated that both focal and whole gland techniques could be appropriate. There was no single preferred dose/fractionation. Conclusion: Areas of consensus within our Delphi study may serve as practical advice for salvage prostate BT. Future research in salvage BT should address areas of controversy identified in our study.(c) 2023 Elsevier B.V. All rights reserved. Radiotherapy and Oncology xxx (2023) xxx-xxx

Original language	English
Article number	109672
Number of pages	6
Journal	Radiotherapy and Oncology
Volume	184
Issue number	1
Early online date	1 May 2023
DOIs	https://doi.org/10.1016/j.radonc.2023.109672
Publication status	Published - 1 Jul 2023

Keywords

Prostate Brachytherapy
Recurrent prostate cancer
Salvage brachytherapy
Delphi consensus
HIGH-DOSE-RATE
RADIATION-THERAPY
RADIOTHERAPY
RELAPSE
MEN

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10.1016/j.radonc.2023.109672

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Corkum, M. T., Buyyounouski, M. K., Chang, A. J., Chung, H. T., Chung, P., Cox, B. W., Crook, J. M., Davis, B. J., Frank, S. J., Henriquez, I., Horwitz, E. M., Hoskin, P., Hsu, I.-C., Keyes, M., King, M. T., Kollmeier, M. A., Krauss, D. J., Kukielka, A. M., Morton, G., ... Kamrava, M. (2023). Salvage prostate brachytherapy in radiorecurrent prostate cancer: An international Delphi consensus study. Radiotherapy and Oncology, 184(1), Article 109672. https://doi.org/10.1016/j.radonc.2023.109672

@article{21c0cec0b7a64534a1bf672b4d0b7cb9,

title = "Salvage prostate brachytherapy in radiorecurrent prostate cancer: An international Delphi consensus study",

abstract = "Background and Purpose: Local recurrences after previous radiotherapy (RT) are increasingly being iden-tified in biochemically recurrent prostate cancer. Salvage prostate brachytherapy (BT) is an effective and well tolerated treatment option. We sought to generate international consensus statements on the use and preferred technical considerations for salvage prostate BT.Materials and Methods: International experts in salvage prostate BT were invited (n = 34) to participate. A three-round modified Delphi technique was utilized, with questions focused on patient-and cancer -specific criteria, type and technique of BT, and follow-up. An a priori threshold for consensus of >= 75% was set, with a majority opinion being >= 50%.Results: Thirty international experts agreed to participate. Consensus was achieved for 56% (18/32) of statements. Consensus was achieved in several areas of patient selection: 1) A minimum of 2-3 years from initial RT to salvage BT; 2) MRI and PSMA PET should be obtained; and 3) Both targeted and system-atic biopsies should be performed. Several areas did not reach consensus: 1) Maximum T stage/PSA at time of salvage; 2) Utilization/duration of ADT; 3) Appropriateness of combining local salvage with SABR for oligometastatic disease and 4) Repeating a second course of salvage BT. A majority opinion pre-ferred High Dose-Rate salvage BT, and indicated that both focal and whole gland techniques could be appropriate. There was no single preferred dose/fractionation. Conclusion: Areas of consensus within our Delphi study may serve as practical advice for salvage prostate BT. Future research in salvage BT should address areas of controversy identified in our study.(c) 2023 Elsevier B.V. All rights reserved. Radiotherapy and Oncology xxx (2023) xxx-xxx",

keywords = "Prostate Brachytherapy, Recurrent prostate cancer, Salvage brachytherapy, Delphi consensus, HIGH-DOSE-RATE, RADIATION-THERAPY, RADIOTHERAPY, RELAPSE, MEN",

author = "Corkum, {Mark T.} and Buyyounouski, {Mark K.} and Chang, {Albert J.} and Chung, {Hans T.} and Peter Chung and Cox, {Brett W.} and Crook, {Juanita M.} and Davis, {Brian J.} and Frank, {Steven J.} and Ivan Henriquez and Horwitz, {Eric M.} and Peter Hoskin and I-Chow Hsu and Mira Keyes and King, {Martin T.} and Kollmeier, {Marisa A.} and Krauss, {Daniel J.} and Kukielka, {Andrzej M.} and Gerard Morton and {Orio III}, {Peter F.} and Pieters, {Bradley R.} and Louis Potters and Rossi, {Peter J.} and Showalter, {Timothy N.} and Solanki, {Abhishek A.} and Daniel Song and Ben Vanneste and Eric Vigneault and Wojcieszek, {Piotr A.} and Zelefsky, {Michael J.} and Mitchell Kamrava",

year = "2023",

month = jul,

day = "1",

doi = "10.1016/j.radonc.2023.109672",

language = "English",

volume = "184",

journal = "Radiotherapy and Oncology",

issn = "0167-8140",

publisher = "Elsevier Ireland Ltd",

number = "1",

}

Corkum, MT, Buyyounouski, MK, Chang, AJ, Chung, HT, Chung, P, Cox, BW, Crook, JM, Davis, BJ, Frank, SJ, Henriquez, I, Horwitz, EM, Hoskin, P, Hsu, I-C, Keyes, M, King, MT, Kollmeier, MA, Krauss, DJ, Kukielka, AM, Morton, G, Orio III, PF, Pieters, BR, Potters, L, Rossi, PJ, Showalter, TN, Solanki, AA, Song, D, Vanneste, B, Vigneault, E, Wojcieszek, PA, Zelefsky, MJ & Kamrava, M 2023, 'Salvage prostate brachytherapy in radiorecurrent prostate cancer: An international Delphi consensus study', Radiotherapy and Oncology, vol. 184, no. 1, 109672. https://doi.org/10.1016/j.radonc.2023.109672

TY - JOUR

T1 - Salvage prostate brachytherapy in radiorecurrent prostate cancer

T2 - An international Delphi consensus study

AU - Corkum, Mark T.

AU - Buyyounouski, Mark K.

AU - Chang, Albert J.

AU - Chung, Hans T.

AU - Chung, Peter

AU - Cox, Brett W.

AU - Crook, Juanita M.

AU - Davis, Brian J.

AU - Frank, Steven J.

AU - Henriquez, Ivan

AU - Horwitz, Eric M.

AU - Hoskin, Peter

AU - Hsu, I-Chow

AU - Keyes, Mira

AU - King, Martin T.

AU - Kollmeier, Marisa A.

AU - Krauss, Daniel J.

AU - Kukielka, Andrzej M.

AU - Morton, Gerard

AU - Orio III, Peter F.

AU - Pieters, Bradley R.

AU - Potters, Louis

AU - Rossi, Peter J.

AU - Showalter, Timothy N.

AU - Solanki, Abhishek A.

AU - Song, Daniel

AU - Vanneste, Ben

AU - Vigneault, Eric

AU - Wojcieszek, Piotr A.

AU - Zelefsky, Michael J.

AU - Kamrava, Mitchell

PY - 2023/7/1

Y1 - 2023/7/1

N2 - Background and Purpose: Local recurrences after previous radiotherapy (RT) are increasingly being iden-tified in biochemically recurrent prostate cancer. Salvage prostate brachytherapy (BT) is an effective and well tolerated treatment option. We sought to generate international consensus statements on the use and preferred technical considerations for salvage prostate BT.Materials and Methods: International experts in salvage prostate BT were invited (n = 34) to participate. A three-round modified Delphi technique was utilized, with questions focused on patient-and cancer -specific criteria, type and technique of BT, and follow-up. An a priori threshold for consensus of >= 75% was set, with a majority opinion being >= 50%.Results: Thirty international experts agreed to participate. Consensus was achieved for 56% (18/32) of statements. Consensus was achieved in several areas of patient selection: 1) A minimum of 2-3 years from initial RT to salvage BT; 2) MRI and PSMA PET should be obtained; and 3) Both targeted and system-atic biopsies should be performed. Several areas did not reach consensus: 1) Maximum T stage/PSA at time of salvage; 2) Utilization/duration of ADT; 3) Appropriateness of combining local salvage with SABR for oligometastatic disease and 4) Repeating a second course of salvage BT. A majority opinion pre-ferred High Dose-Rate salvage BT, and indicated that both focal and whole gland techniques could be appropriate. There was no single preferred dose/fractionation. Conclusion: Areas of consensus within our Delphi study may serve as practical advice for salvage prostate BT. Future research in salvage BT should address areas of controversy identified in our study.(c) 2023 Elsevier B.V. All rights reserved. Radiotherapy and Oncology xxx (2023) xxx-xxx

AB - Background and Purpose: Local recurrences after previous radiotherapy (RT) are increasingly being iden-tified in biochemically recurrent prostate cancer. Salvage prostate brachytherapy (BT) is an effective and well tolerated treatment option. We sought to generate international consensus statements on the use and preferred technical considerations for salvage prostate BT.Materials and Methods: International experts in salvage prostate BT were invited (n = 34) to participate. A three-round modified Delphi technique was utilized, with questions focused on patient-and cancer -specific criteria, type and technique of BT, and follow-up. An a priori threshold for consensus of >= 75% was set, with a majority opinion being >= 50%.Results: Thirty international experts agreed to participate. Consensus was achieved for 56% (18/32) of statements. Consensus was achieved in several areas of patient selection: 1) A minimum of 2-3 years from initial RT to salvage BT; 2) MRI and PSMA PET should be obtained; and 3) Both targeted and system-atic biopsies should be performed. Several areas did not reach consensus: 1) Maximum T stage/PSA at time of salvage; 2) Utilization/duration of ADT; 3) Appropriateness of combining local salvage with SABR for oligometastatic disease and 4) Repeating a second course of salvage BT. A majority opinion pre-ferred High Dose-Rate salvage BT, and indicated that both focal and whole gland techniques could be appropriate. There was no single preferred dose/fractionation. Conclusion: Areas of consensus within our Delphi study may serve as practical advice for salvage prostate BT. Future research in salvage BT should address areas of controversy identified in our study.(c) 2023 Elsevier B.V. All rights reserved. Radiotherapy and Oncology xxx (2023) xxx-xxx

KW - Prostate Brachytherapy

KW - Recurrent prostate cancer

KW - Salvage brachytherapy

KW - Delphi consensus

KW - HIGH-DOSE-RATE

KW - RADIATION-THERAPY

KW - RADIOTHERAPY

KW - RELAPSE

KW - MEN

U2 - 10.1016/j.radonc.2023.109672

DO - 10.1016/j.radonc.2023.109672

M3 - Article

C2 - 37059334

SN - 0167-8140

VL - 184

JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

IS - 1

M1 - 109672

ER -