Urethra-sparing prostate cancer radiotherapy: Current practices and future insights from an international survey
Purpose: In prostate cancer patients, high radiation doses to the urethra have been associated with an increased risk of severe genitourinary toxicity following dose-escalated radiotherapy. Urethra-sparing techniques have emerged as a promising approach to reduce urinary toxicity. This international...
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Elsevier
2025-03-01
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| Series: | Clinical and Translational Radiation Oncology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405630824001848 |
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| author | Jennifer Le Guévelou Paul Sargos Piet Ost Filippo Alongi Stefano Arcangeli Alejandro Berlin Pierre Blanchard Anna Bruynzeel Olivier Chapet Alan Dal Pra Robert T. Dess Matthias Guckenberger Andrew Loblaw Amar U. Kishan Barbara Alicja Jereczek-Fossa David Pasquier Mohamed Shelan Shankar Siva Alison C. Tree Costantinos Zamboglou Stephane Supiot Vedang Murthy Thomas Zilli |
| author_facet | Jennifer Le Guévelou Paul Sargos Piet Ost Filippo Alongi Stefano Arcangeli Alejandro Berlin Pierre Blanchard Anna Bruynzeel Olivier Chapet Alan Dal Pra Robert T. Dess Matthias Guckenberger Andrew Loblaw Amar U. Kishan Barbara Alicja Jereczek-Fossa David Pasquier Mohamed Shelan Shankar Siva Alison C. Tree Costantinos Zamboglou Stephane Supiot Vedang Murthy Thomas Zilli |
| author_sort | Jennifer Le Guévelou |
| collection | DOAJ |
| description | Purpose: In prostate cancer patients, high radiation doses to the urethra have been associated with an increased risk of severe genitourinary toxicity following dose-escalated radiotherapy. Urethra-sparing techniques have emerged as a promising approach to reduce urinary toxicity. This international survey aims to evaluate current global practices in urethra-sparing and explore future directions for the implementation of this technique in external beam radiotherapy (EBRT) for prostate cancer. Methods and materials: In April 2024, a survey consisting of 20 questions was distributed to 26 international radiation oncology experts in prostate cancer EBRT, with 23 experts participating. The survey focused on clinical scenarios which might take benefit from urethra-sparing, the definition of the urethra and urinary organs-at-risk, and urethral dose constraints. Results: Magnetic resonance imaging with T2-weighted sequences is the preferred method for urethra contouring (83 % consensus). Based on the experts opinion, urethra-sparing should be considered for prostate cancer EBRT, regardless of pelvic irradiation, except in cases where the tumor is located within 2 mm of the urethra and/or transitional zone, or in T4 disease. Most experts would not apply specific dose constraints to the urethra for either conventional or moderate hypofractionation regimens. When delivering stereotactic body radiotherapy (SBRT), urethra-sparing with dose hotspot limitation (urethra steering) is recommended by 70 % of the experts, in particular when combined with focal boosting (91 %). Urethra dose-reduction is also the favored approach for salvage prostate reirradiation with SBRT (70 % agreement). Large variations exists regarding urethral dose constraints. Conclusions: Urethra-sparing is a promising technique for the mitigation of urinary toxicity in prostate cancer patients undergoing EBRT, particularly recommended for ultra-hypofractionation and reirradiation with SBRT. The lack of consensus on specific urethral dose constraints and optimal sparing techniques underscores the need for further research to standardize practices in this field. |
| format | Article |
| id | doaj-art-08f946450d624dd09218590f0375a620 |
| institution | Kabale University |
| issn | 2405-6308 |
| language | English |
| publishDate | 2025-03-01 |
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| series | Clinical and Translational Radiation Oncology |
| spelling | doaj-art-08f946450d624dd09218590f0375a6202025-01-30T05:14:28ZengElsevierClinical and Translational Radiation Oncology2405-63082025-03-0151100907Urethra-sparing prostate cancer radiotherapy: Current practices and future insights from an international surveyJennifer Le Guévelou0Paul Sargos1Piet Ost2Filippo Alongi3Stefano Arcangeli4Alejandro Berlin5Pierre Blanchard6Anna Bruynzeel7Olivier Chapet8Alan Dal Pra9Robert T. Dess10Matthias Guckenberger11Andrew Loblaw12Amar U. Kishan13Barbara Alicja Jereczek-Fossa14David Pasquier15Mohamed Shelan16Shankar Siva17Alison C. Tree18Costantinos Zamboglou19Stephane Supiot20Vedang Murthy21Thomas Zilli22Department of Clinical Research, Centre Eugène Marquis, Rennes, France; Laboratoire du traitement du signal et de l’image, Université De Rennes, Rennes, FranceDepartment of Radiation Oncology, Institut Bergonié, Bordeaux, France; Department of Radiotherapy, Charlebourg Center, La Garenne-Colombes, FranceDepartment of Human Structure and Repair, Ghent University, Ghent, Belgium; Iridium Network, Radiation Oncology, Wilrijk, BelgiumAdvanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Italy; University of Brescia, Brescia, ItalyRadiation Oncology Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; School of Medicine and Surgery, University of Milan Bicocca, Milan, ItalyDepartment of Radiation Oncology, Princess Margaret Cancer Center, University Health Network and University of Toronto, Toronto, Ontario, CanadaDepartment of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, FranceAmsterdam UMC Location Vrije Universiteit Amsterdam, Department of Radiation Oncology, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, NetherlandsDepartment of Radiation Oncology, Hôpital Lyon Sud, Lyon, France; Université Claude-Bernard Lyon 1, Villeurbanne, FranceDepartment of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Health Systems, Miami, FL, USADepartment of Radiation Oncology, University of Michigan, Ann Arbor, MI, USADepartment of Radiation Oncology, University Hospital Zürich, University of Zürich, Zürich, SwitzerlandInstitute of Healthcare Policy and Management, Department of Radiation Oncology, Ontario Institute of Cancer Research, University of Toronto, Toronto, Ontario, CanadaDepartment of Radiation Oncology, University of California, Los Angeles, CA, USADepartment of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Department of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, ItalyDepartment of Radiation Oncology, Centre Oscar Lambret, Lille, France; CRIStAL UMR CNRS 9189, Lille University, Lille, FranceDepartment of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, SwitzerlandDivision of Radiation Oncology and Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Center, University of Melbourne, Melbourne, Victoria, AustraliaDepartment of Radiation Oncology, The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UKGerman Oncology Center, European University of Cyprus, 1 Nikis Avenue, 4108, Agios Athanasios, Cyprus; Department of Radiation Oncology, University Hospital Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, GermanyDepartment of Radiation Oncology, University Hospital Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany; Radiation Oncology Department, Institut de Cancérologie de l’Ouest, Nantes Saint-Herblain, France; CNRS US2B, University of Nantes, Nantes, France; Department of Radiation Oncology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai, IndiaDepartment of Radiation Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, SwitzerlandDepartment of Radiation Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Corresponding author at: Radiation Oncology, Oncology Institute of Southern Switzerland (IOSI), EOC, CH-6500 Bellinzona, Switzerland.Purpose: In prostate cancer patients, high radiation doses to the urethra have been associated with an increased risk of severe genitourinary toxicity following dose-escalated radiotherapy. Urethra-sparing techniques have emerged as a promising approach to reduce urinary toxicity. This international survey aims to evaluate current global practices in urethra-sparing and explore future directions for the implementation of this technique in external beam radiotherapy (EBRT) for prostate cancer. Methods and materials: In April 2024, a survey consisting of 20 questions was distributed to 26 international radiation oncology experts in prostate cancer EBRT, with 23 experts participating. The survey focused on clinical scenarios which might take benefit from urethra-sparing, the definition of the urethra and urinary organs-at-risk, and urethral dose constraints. Results: Magnetic resonance imaging with T2-weighted sequences is the preferred method for urethra contouring (83 % consensus). Based on the experts opinion, urethra-sparing should be considered for prostate cancer EBRT, regardless of pelvic irradiation, except in cases where the tumor is located within 2 mm of the urethra and/or transitional zone, or in T4 disease. Most experts would not apply specific dose constraints to the urethra for either conventional or moderate hypofractionation regimens. When delivering stereotactic body radiotherapy (SBRT), urethra-sparing with dose hotspot limitation (urethra steering) is recommended by 70 % of the experts, in particular when combined with focal boosting (91 %). Urethra dose-reduction is also the favored approach for salvage prostate reirradiation with SBRT (70 % agreement). Large variations exists regarding urethral dose constraints. Conclusions: Urethra-sparing is a promising technique for the mitigation of urinary toxicity in prostate cancer patients undergoing EBRT, particularly recommended for ultra-hypofractionation and reirradiation with SBRT. The lack of consensus on specific urethral dose constraints and optimal sparing techniques underscores the need for further research to standardize practices in this field.http://www.sciencedirect.com/science/article/pii/S2405630824001848UrethraProstate cancerSBRTRadiotherapyToxicity |
| spellingShingle | Jennifer Le Guévelou Paul Sargos Piet Ost Filippo Alongi Stefano Arcangeli Alejandro Berlin Pierre Blanchard Anna Bruynzeel Olivier Chapet Alan Dal Pra Robert T. Dess Matthias Guckenberger Andrew Loblaw Amar U. Kishan Barbara Alicja Jereczek-Fossa David Pasquier Mohamed Shelan Shankar Siva Alison C. Tree Costantinos Zamboglou Stephane Supiot Vedang Murthy Thomas Zilli Urethra-sparing prostate cancer radiotherapy: Current practices and future insights from an international survey Clinical and Translational Radiation Oncology Urethra Prostate cancer SBRT Radiotherapy Toxicity |
| title | Urethra-sparing prostate cancer radiotherapy: Current practices and future insights from an international survey |
| title_full | Urethra-sparing prostate cancer radiotherapy: Current practices and future insights from an international survey |
| title_fullStr | Urethra-sparing prostate cancer radiotherapy: Current practices and future insights from an international survey |
| title_full_unstemmed | Urethra-sparing prostate cancer radiotherapy: Current practices and future insights from an international survey |
| title_short | Urethra-sparing prostate cancer radiotherapy: Current practices and future insights from an international survey |
| title_sort | urethra sparing prostate cancer radiotherapy current practices and future insights from an international survey |
| topic | Urethra Prostate cancer SBRT Radiotherapy Toxicity |
| url | http://www.sciencedirect.com/science/article/pii/S2405630824001848 |
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