An international Delphi consensus for pelvic Stereotactic Ablative Radiotherapy re-irradiation

27siStereotactic Ablative Radiotherapy (SABR) is increasingly used to treat metastatic oligorecurrence and locoregional recurrences but limited evidence/guidance exists in the setting of pelvic re-irradiation. An international Delphi study was performed to develop statements to guide practice regarding patient selection, pre-treatment investigations, treatment planning, delivery and cumulative organs at risk (OARs) constraints.nonenoneSlevin, Finbar; Aitken, Katharine; Alongi, Filippo; Arcangeli, Stefano; Chadwick, Eliot; Chang, Ah Ram; Cheung, Patrick; Crane, Christopher; Guckenberger, Matthias; Jereczek-Fossa, Barbara Alicja; Kamran, Sophia C; Kinj, Rémy; Loi, Mauro; Mahadevan, Anand; Massaccesi, Mariangela; Mendez, Lucas C; Muirhead, Rebecca; Pasquier, David; Pontoriero, Antonio; Spratt, Daniel E; Tsang, Yat Man; Zelefsky, Michael J; Lilley, John; Dickinson, Peter; Hawkins, Maria A; Henry, Ann M; Murray, Louise JSlevin, Finbar; Aitken, Katharine; Alongi, Filippo; Arcangeli, Stefano; Chadwick, Eliot; Chang, Ah Ram; Cheung, Patrick; Crane, Christopher; Guckenberger, Matthias; Jereczek-Fossa, Barbara Alicja; Kamran, Sophia C; Kinj, Rémy; Loi, Mauro; Mahadevan, Anand; Massaccesi, Mariangela; Mendez, Lucas C; Muirhead, Rebecca; Pasquier, David; Pontoriero, Antonio; Spratt, Daniel E; Tsang, Yat Man; Zelefsky, Michael J; Lilley, John; Dickinson, Peter; Hawkins, Maria A; Henry, Ann M; Murray, Louise

An international Delphi consensus for pelvic stereotactic ablative radiotherapy re-irradiation

Introduction Stereotactic Ablative Radiotherapy (SABR) is increasingly used to treat metastatic oligorecurrence and locoregional recurrences but limited evidence/guidance exists in the setting of pelvic re-irradiation. An international Delphi study was performed to develop statements to guide practice regarding patient selection, pre-treatment investigations, treatment planning, delivery and cumulative organs at risk (OARs) constraints. Materials and methods Forty-one radiation oncologists were invited to participate in three online surveys. In Round 1, information and opinion was sought regarding participants’ practice. Guidance statements were developed using this information and in Round 2 participants were asked to indicate their level of agreement with each statement. Consensus was defined as ≥75% agreement. In Round 3, any statements without consensus were re-presented unmodified, alongside a summary of comments from Round 2. Results Twenty-three radiation oncologists participated in Round 1 and, of these, 21 (91%) and 22 (96%) completed Rounds 2 and 3 respectively. Twenty-nine of 44 statements (66%) achieved consensus in Round 2. The remaining 15 statements (34%) did not achieve further consensus in Round 3. Consensus was achieved for 10 of 17 statements (59%) regarding patient selection/pre-treatment investigations; 12 of 13 statements (92%) concerning treatment planning and delivery; and 7 of 14 statements (50%) relating to OARs. Lack of agreement remained regarding the minimum time interval between irradiation courses, the number/size of pelvic lesions that can be treated and the most appropriate cumulative OAR constraints. Conclusions This study has established consensus, where possible, in areas of patient selection, pre-treatment investigations, treatment planning and delivery for pelvic SABR re-irradiation for metastatic oligorecurrence and locoregional recurrences. Further research into this technique is required, especially regarding aspects of practice where consensus was not achieved

Role of elevated plasma soluble ICAM-1 and bronchial lavage fluid IL-8 levels as markers of chronic lung disease in premature infants.

BACKGROUND--Pulmonary neutrophilia characterises both the relatively transient inflammation associated with infant respiratory distress syndrome (IRDS) and the persistent inflammation of chronic lung disease. The possibility that persistently raised markers of inflammation indicate the development of chronic lung disease in low birth weight (< 1730 g) preterm (< 31 weeks) infants was therefore investigated. METHODS--Soluble ICAM-1 (sICAM-1) levels in plasma, and interleukin (IL)-8 and myeloperoxidase (MPO) levels in bronchial lavage fluid (BLF) obtained from 17 infants on days 1, 5, and 14 following birth were measured and correlations with the number of neutrophils in BLF sought. Peripheral neutrophils were isolated on Polymorphoprep and chemotactic responsiveness to IL-8 was assessed using micro Boyden chambers. RESULTS--Sixteen infants developed IRDS and, of these, 10 infants subsequently developed chronic lung disease. Levels of IL-8 in BLF at 14 days of age correlated with the long term requirement for intermittent positive pressure ventilation (IPPV). Interleukin 8 levels in BLF correlated with neutrophil numbers and MPO concentration, suggesting both recruitment and activation in response to this cytokine. Antibody depletion studies showed that approximately 50% of total neutrophil chemotactic activity in BLF was due to IL-8. No difference in peripheral neutrophil chemotactic responsiveness at any age was observed for infants with IRDS or chronic lung disease. Plasma soluble intercellular adhesion molecule (sICAM-1) was higher at 14 days of age in infants who developed chronic lung disease than in those with resolving IRDS, and correlated with severity of disease, as indicated by duration of IPPV. CONCLUSIONS--The results indicate that high levels of plasma sICAM-1 and IL-8 in BLF at day 14 correlate with the development of chronic lung disease and indicate the severity of disease