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Consensus and differences in primary radiotherapy for localized and locally advanced prostate cancer in Switzerland

A survey on patterns of practice

Gemeinsamkeiten und Unterschiede der primären Radiotherapie beim lokalisierten und lokal fortgeschrittenen Prostatakarzinom in der Schweiz

Eine Analyse der der Behandlungskonzepte

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Abstract

Introduction

External beam radiotherapy (EBRT), with or without androgen deprivation therapy (ADT), is an established treatment option for nonmetastatic prostate cancer. Despite high-level evidence from several randomized trials, risk group stratification and treatment recommendations vary due to contradictory or inconclusive data, particularly with regard to EBRT dose prescription and ADT duration. Our aim was to investigate current patterns of practice in primary EBRT for prostate cancer in Switzerland.

Materials and methods

Treatment recommendations on EBRT and ADT for localized and locally advanced prostate cancer were collected from 23 Swiss radiation oncology centers. Written recommendations were converted into center-specific decision trees, and analyzed for consensus and differences using a dedicated software tool. Additionally, specific radiotherapy planning and delivery techniques from the participating centers were assessed.

Results

The most commonly prescribed radiation dose was 78 Gy (range 70–80 Gy) across all risk groups. ADT was recommended for intermediate-risk patients for 6 months in over 80 % of the centers, and for high-risk patients for 2 or 3 years in over 90 % of centers. For recommendations on combined EBRT and ADT treatment, consensus levels did not exceed 39 % in any clinical scenario. Arc-based intensity-modulated radiotherapy (IMRT) is implemented for routine prostate cancer radiotherapy by 96 % of the centers.

Conclusion

Among Swiss radiation oncology centers, considerable ranges of radiotherapy dose and ADT duration are routinely offered for localized and locally advanced prostate cancer. In the vast majority of cases, doses and durations are within the range of those described in current evidence-based guidelines.

Zusammenfassung

Einleitung

Die Radiotherapie (RT) ist als Monotherapie oder in Kombination mit einer Androgendeprivationstherapie (ADT) eine etablierte Behandlungsoption für das lokalisierte und lokal fortgeschrittene Prostatakarzinom. Trotz der guten Evidenzlage durch zahlreiche randomisierte Studien bestehen weiterhin unterschiedliche Behandlungskonzepte, die besonders hinsichtlich der Gesamtdosis der RT sowie der Dauer der ADT variieren. Das Ziel der vorliegenden Studie ist eine Analyse der Behandlungskonzepte für die kurative RT des Prostatakarzinoms in der Schweiz.

Material und Methoden

Die Behandlungsempfehlungen für das lokalisierte und lokal fortgeschrittene Prostatakarzinom bezüglich Bestrahlungsdosis und ADT-Dauer wurden von 23 Schweizer Zentren für Strahlentherapie eingeholt. Die einzelnen Empfehlungen wurden mittels einer speziellen Software in zentrumsspezifische Therapiealgorithmen umgewandelt und automatisch auf Konsens und Differenzen mit den übrigen Zentren verglichen. Zusätzlich erfolgte eine Umfrage über den Einsatz besonderer Behandlungstechniken.

Ergebnisse

Die am häufigsten verschriebene Gesamtdosis war 78 Gy für alle Risikogruppen (Spanne 70–80 Gy). Eine ADT wurde für Patienten der mittleren Risikogruppe für 6 Monate von über 80 % der Zentren und für Hochrisiko-Patienten für 2–3 Jahre von über 90 % der Zentren empfohlen. Für die kombinierten Therapieempfehlungen bezüglich RT-Gesamtdosis und ADT-Dauer ergab sich in keinem klinischen Szenario ein Konsens von mehr als 39 %. Intensitätsmodulierte Rotationstechniken werden in 96 % der Zentren als Standard für die RT des Prostatakarzinoms verwendet.

Schlussfolgerung

In der Therapie des lokalisierten und lokal fortgeschrittenen Prostatakarzinoms werden in der Schweiz verschiedene Therapiekonzepte bezüglich RT-Gesamtdosis und ADT-Dauer angeboten, die in der überwiegenden Mehrheit innerhalb der von evidenzbasierten Leitlinien empfohlenen Spanne liegen.

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Acknowledgements

We would like to thank the following representatives for their active participation in data collection and conversion: Beat Amsler, Radio-Onkologie Amsler AG; Jacques Bernier, Clinique de Genolier; Kathrin Brouwer, Stadtspital Triemli; Tim Collen, Kantonsspital Luzern; Alessandra Franzetti-Pellanda, Clinica Luganese; Andreas Geretschläger, Claraspital Basel; Thomas Lippuner, Kantonsspital Winterthur; Yousef Najafi, Universitätsspital Zürich; Markus Notter, Hôpital neuchâtelois; Gianfranco Pesce, Ente Ospedaliero Cantonale; Christiane Reuter, Kantonsspital Münsterlingen; Olalla Santa Cruz, Hôpital de Sion; Marcin Sumila, Klinik Hirslanden; Istvan Takacs, Kantonsspital Aarau; Armin Thöni, Lindenhofspital Bern; Abderrahim Zouhair, Clinique de la Source Lausanne.

Funding

This study was funded by a grant from the research commission of the Kantonsspital St. Gallen (Forschungsförderung KSSG).

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Authors and Affiliations

  1. Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland

    Cédric M. Panje M.D., Ludwig Plasswilm M.D. & Paul Martin Putora M.D. Ph.D. M.A.

  2. Department of Radiation Oncology, Universitätsspital Zürich, Zurich, Switzerland

    Cédric M. Panje M.D.

  3. Department of Radiation Oncology, Inselspital Bern, Bern, Switzerland

    Alan Dal Pra M.D.

  4. Department of Radiation Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland

    Thomas Zilli M.D.

  5. Department of Radiation Oncology, Kantonsspital Graubünden, Chur, Switzerland

    Daniel R. Zwahlen M.D., M.B.A.

  6. Department of Radiation Oncology, Universitätsspital Basel, Basel, Switzerland

    Alexandros Papachristofilou M.D.

  7. Department of Radiation Oncology, Centre hospitalier universitaire vaudois, Lausanne, Switzerland

    Fernanda G. Herrera M.D.

  8. Department of Radiation Oncology, Hôpital Riviera-Chablais, Vevey, Switzerland

    Oscar Matzinger M.D. P.D.

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  1. Cédric M. Panje M.D.
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  2. Alan Dal Pra M.D.
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  4. Daniel R. Zwahlen M.D., M.B.A.
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  8. Ludwig Plasswilm M.D.
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  9. Paul Martin Putora M.D. Ph.D. M.A.
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Correspondence to Paul Martin Putora M.D. Ph.D. M.A..

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Conflict of interest

C. Panje, A. Dal Pra, T. Zilli, D. Zwahlen, A. Papachristofilou, F.G. Herrera, O. Matzinger, L. Plasswilm, and P.M. Putora state that there are no conflicts of interest.

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Panje, C., Dal Pra, A., Zilli, T. et al. Consensus and differences in primary radiotherapy for localized and locally advanced prostate cancer in Switzerland. Strahlenther Onkol 191, 778–786 (2015). https://doi.org/10.1007/s00066-015-0849-8

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