![]() The systematic review utilized to inform this guideline was conducted by an independent methodological consultant. This guideline covers advanced prostate cancer, including disease stages that range from prostate-specific antigen (PSA) recurrence after exhaustion of local treatment options to widespread metastatic disease. To assist in clinical decision-making, evidence-based guideline statements were developed to provide a rational basis for evidence-based treatment. The management of advanced prostate cancer is rapidly evolving. Physician Scientist Residency Training Awards Resources for Coding and Reimbursement Processīoston Scientific Medical Student Innovation Fellowship Urology Scientific Mentoring and Research Training (USMART)īrandeis University’s Executive MBA for Physicians Section Meeting Request for Course of ChoiceĬonfidentiality Statement for Online EducationĪdvanced Practice Providers Speaker's BureauĪctivities for the AUA Leadership Program Urology Residency ProgramsĪdditional Fellowships for InternationalsĬontinuing Medical Education & AccreditationĪUA Continuing Education (CE) Mission Statement Transgender and Gender Diverse Patient CareĪccredited Listing of U.S. Request a Hands-on Urologic Ultrasound Course Training Guidelines for Urologic Ultrasound Urologic Ultrasound Practice Accreditation Practice Guideline for Urologic Ultrasound Young Urologists Annual Meeting Programming Young Urologists of the Year Award Winners Residents and Fellows Committee Teaching AwardĪUA Residents and Fellows Committee Teaching Award Residents and Fellows Committee Essay Contest Additional prospective data are needed, and toxicities should be correlated with reRT course and composite dose constraints.Volunteer Opportunities for Residents and Young UrologistsĪUA Advanced Practice Provider of the Year Award Recommended reRT composite dose constraints in 2 Gy equivalent dose are: esophagus V60 <40% and DMax <100-110 Gy, lung V20 <40%, heart V40 <50%, aorta/great vessels DMax <120 Gy, trachea and proximal bronchial tree DMax <110 Gy, spinal cord DMax <57 Gy, and brachial plexus DMax <85 Gy.Ĭonclusions: For the first time, consensus dose constraints for thoracic reRT are recommended to minimize the risks of high-grade and potentially fatal toxicities from repeat radiotherapy. Stereotactic body radiation therapy (SBRT) can provide increased conformality and dose escalation and is optimal for primary-alone failures, but caution is needed for central reRT with SBRT. Particle therapy may further reduce toxicities and/or enable safer reRT dose escalation compared with 3DCRT and IMRT. For conventionally fractionated reRT, intensity-modulated radiation therapy (IMRT) is recommended over 3D conformal radiation therapy (3DCRT) to increase dose conformality. ![]() Limited data exist regarding the use of hyperfractionation and low- or high-dose rate reRT for NSCLC. Acute esophagitis and pneumonitis and late pulmonary, cardiac/great vessel, esophageal, brachial plexus and spinal toxicities are dose limiting for reRT. ![]() There are no data to guide the use of concurrent targeted therapy or immunotherapy with reRT, and this is not recommended outside of a clinical trial. The available data suggest potential benefit in clinical outcomes with concurrent chemoradiation for reRT, but the decision should be based on patient performance status, tolerance to prior systemic therapy and other individual patient/tumor characteristics. Composite dose constraints were also recommended. Of 236 articles, 49 remained after exclusions (3 prospective) and formed the basis for these recommendations on: 1) the role of concurrent chemotherapy with reRT, 2) factors associated with toxicity from reRT and 3) what reRT modalities, dose-fractionation schemas and dose rates should be used. Methods: A PRISMA systematic review assessed all studies published through 3/2019 evaluating toxicities, local control and/or overall survival for NSCLC thoracic reRT. Objectives: This ARS-ACR Appropriate Use Criteria Systematic Review and Guidelines on Reirradiation for NSCLC provides direct guidance on the safety and efficacy of reRT and recommends consensus dose constraints for thoracic reRT to minimize risks of high grade toxicities. To date, no systematic review on the safety and efficacy of reRT for NSCLC exists, and no dedicated guidelines are available. Thoracic reRT, however, is particularly challenging due to its considerable risk and the current lack of standardized approaches, guidelines and dose constraints. Background: Reirradiation (reRT) for locoregional recurrences can provide durable control and improved symptoms and progression-free survival for select NSCLC patients. ![]()
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