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The “PROCAINA (PROstate CAncer INdication Attitudes) Project” (Part II) — A survey among Italian radiation oncologists on radical radiotherapy in prostate cancer

Il progetto PROCAINA (PROstate CAncer INdication Attitudes) (Parte II) — Una survey tra gli oncologi radioterapisti italiani sulla radioterapia radicale per il tumore prostatico

  • Radiotherapy / Radioterapia
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Abstract

Purpose

Radiotherapy (RT) has an established role in the treatment of prostate cancer patients. Despite the large number of patients treated with RT, some issues about optimal techniques, doses, volumes, timing, and association with androgen deprivation are still subject of debate. The aim of this survey was to determine the patterns of choice of Italian radiation oncologists in two different clinical cases of prostate cancer patients treated with radical RT.

Study design

During the 2010 Italian Association of Radiation Oncology (AIRO) National congress, four different clinical cases were presented to attending radiation oncologists. Two of them were prostate cancer cases that could be treated by RT +/− hormonal therapy (HT), different for T stage of primary tumour according to TNM, preoperative diagnostic procedures for staging, initial prostate specific antigen (iPSA), and Gleason Score sum of biopsy. For each clinical case, radiation oncologists were asked to: (a) give indication to pretreatment procedures for staging; (b) give indication to treatment; (c) define specifically, where indicated, total dose, type of fractionation, volumes of treatment, type of technique, type of image-guided setup control; (d) indicate if HT should be prescribed; (e) define criteria that particularly influenced prescription. A descriptive statistical analysis was performed.

Results

Three hundred questionnaires were given to radiation oncologists attending the congress, 128 questionnaires were completed and considered for this analysis (41%). Some important differences were shown in prescribing and delivering RT, particularly with regards to treatment volumes and fractionation.

Conclusions

Despite the results of clinical trials, several differences still exist among Italian radiation oncologists in the treatment of prostate cancer patients. These patients probably deserve a more uniform approach, based on upto-date, detailed, and evidence-based recommendations.

Riassunto

Obiettivo

La radioterapia (RT) ricopre un ruolo ben stabilito nel trattamento dei pazienti con tumore della prostata. Nonostante il grande numero di pazienti trattati con RT, alcune controversie circa la tecnica ottimale di trattamento, le dosi, i volumi, il timing rispetto alla chirurgia e l’associazione con la terapia ormonale sono ancora oggetto di dibattito. Lo scopo di questa indagine è stato di determinare la modalità di scelta di trattamento degli oncologi radioterapisti italiani in 2 diversi casi clinici di pazienti affetti da tumore prostatico trattati con RT a scopo radicale.

Disegno di studio

Durante il Congresso Nazionale dell’Associazione Italiana di Radioterapia Oncologica (AIRO) del 2010, 4 casi clinici sono stati proposti agli oncologi radioterapisti presenti. Due di questi casi clinici si presentavano adeguati alla RT a scopo radicale +/− ormonoterapia (OT), ed erano diversi per stadio clinico, procedure diagnostiche di staging pre-trattamento, antigene specifico della prostata (PSA) iniziale, Gleason Score bioptico. Per ogni caso clinico si chiedeva di (a) dare indicazione a nuove procedure di staging pre-trattamento; (b) dare indicazione al trattamento; (c) definire in particolare, se indicato, la dose totale, il tipo di frazionamento, i volumi di trattamento, il tipo di tecnica, il tipo di controllo del set-up guidato dalle immagini; (d) dare indicazione a un trattamento ormonale eventuale; (e) definire i criteri maggiormente influenzanti la prescrizione. è stata eseguita un’analisi descrittiva delle risposte.

Risultati

Trecento questionari sono stati consegnati agli oncologi radioterapisti partecipanti; 128 sono stati correttamente compilati e considerati per questa analisi (41%). Alcune importanti differenze sono state messe in evidenza nella prescrizione e nell’erogazione della RT, particolarmente riguardanti i volumi di trattamento e il frazionamento della dose. Sono state evidenziate alcune differenze con le raccomandazioni internazionali e i dati disponibili in letteratura sono stati rivisti e discussi.Conclusioni

Conclusioni

Nonostante i risultati di diversi studi clinici, persistono alcune differenze significative tra gli oncologi radioterapisti italiani nel trattamento dei pazienti con tumore prostatico. Questi pazienti meriterebbero un approccio più uniforme basato su raccomandazioni aggiornate, dettagliate e condivise sulla base delle evidenze disponibili.

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Authors and Affiliations

  1. Radiotherapy Department, Istituto del Radio “O. Alberti”, Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia, Italy

    Berardino De Bari

  2. Radiotherapy and Radiosurgery Department, Istituto Clinico Humanitas, Humanitas Cancer Center, Rozzano-Milano, Italy

    Filippo Alongi

  3. Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale “U. Parini”, AUSL Valle d’Aosta, Aosta, Italy

    Pierfrancesco Franco

  4. Radiotherapy Department, IRCCS-Arcispedale S. Maria Nuova, Reggio Emilia, Italy

    Patrizia Ciammella

  5. Service d’Oncologie Radiothérapie, CHU Ibn Rochd, Casablanca, Morocco

    Tarik Chekrine

  6. Department of Radiation Oncology, University of Florence, Florence, Italy

    Lorenzo Livi

  7. Division of Radiotherapy, European Institute of Oncology and University of Milan, Milan, Italy

    Barbara A. Jereczek-Fossa

  8. Department of Medical and Surgical Sciences, Radiation Oncology Unit, University of Turin, Turin, Italy

    Andrea Riccardo Filippi

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  1. Berardino De Bari
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AIRO Young and AIRO Prostate cancer Working Group

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Correspondence to Berardino De Bari.

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De Bari, B., Alongi, F., Franco, P. et al. The “PROCAINA (PROstate CAncer INdication Attitudes) Project” (Part II) — A survey among Italian radiation oncologists on radical radiotherapy in prostate cancer. Radiol med 118, 1220–1239 (2013). https://doi.org/10.1007/s11547-013-0925-z

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