title: Consensus and differences in primary radiotherapy for localized and locally advanced prostate cancer in Switzerland: A survey on patterns of practice.
abstract: BACKGROUND
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.|Department of Radiation Oncology, Universitätsspital Zürich, Zurich, Switzerland.
authors.forename: Cédric M
authors.initials: CM
authors.lastname: Panje
authors.affiliation: Department of Radiation Oncology, Inselspital Bern, Bern, Switzerland.
authors.forename: Alan
authors.initials: A
authors.lastname: Dal Pra
authors.affiliation: Department of Radiation Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zilli
authors.affiliation: Department of Radiation Oncology, Kantonsspital Graubünden, Chur, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: R Zwahlen
authors.affiliation: Department of Radiation Oncology, Universitätsspital Basel, Basel, Switzerland.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Papachristofilou
authors.affiliation: Department of Radiation Oncology, Centre hospitalier universitaire vaudois, Lausanne, Switzerland.
authors.forename: Fernanda G
authors.initials: FG
authors.lastname: Herrera
authors.affiliation: Department of Radiation Oncology, Hôpital Riviera-Chablais, Vevey, Switzerland.
authors.forename: Oscar
authors.initials: O
authors.lastname: Matzinger
authors.affiliation: Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Plasswilm
authors.affiliation: Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland. paulmartin.putora@kssg.ch.
authors.forename: Paul Martin
authors.initials: PM
authors.lastname: Putora
mesh_terms: D000726:Androgen Antagonists / Q000627:therapeutic use; D003131:Combined Modality Therapy; D032921:Consensus; D003663:Decision Trees; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010818:Practice Patterns, Physicians'; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D013557:Switzerland
chemical_list: D000726:Androgen Antagonists
keywords: Decision trees; Guidelines; Radiation oncology; Radiotherapy, intensity-modulated; Risk