S1239
Clinical - Urology
ESTRO 2026
Bologna, Italy. 5 Dipartimento di Oncologia, Università di Torino, Torino, Italy. 6 Comprehensive Cancer Center, Oncology Unit, Fondazione Policlinico Universitario "A. Gemelli," IRCCS,, Rome, Italy. 7 Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy. 8 Radioterapia Oncologica, Fondazione Policlinico Universitario «Agostino Gemelli» IRCCS, Rome, Italy. 9 Onco-Hematological Diseases, UOC Azienda Ospedaliera Giuseppe Moscati, Avellino, Italy. 10 Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy. 11 UO di Oncologia Medica e Terapia Biomolecolare, Azienda OspedalieroUniversitaria “Ospedali Riuniti”, Foggia, Italy. 12 Oncology 3 Unite, Veneto Institute of Oncology, Padova, Italy. 13 Medical Oncology 1U Department of Oncology, Città della Salute e della Scienza di Torino, Torino, Italy. 14 Department of Clinical Medicine and Surgery at University of Naples Federico II, University of Naples Federico II, Napoli, Italy. 15 Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy. 16 Medical Oncology Unit, Macerata General Hospital, Macerata, Italy. 17 Fondazione Pascale, IRCCS, Istituto Nazionale dei Tumori, Napoli, Italy. 18 Unit of Urology and Renal Transplantation, Careggi University Hospital, Florence, Italy. 19 Division of Oncology, Department of Oncology and Hematology,, University Hospital of Modena, Modena, Italy. 20 Oncologia medica, Ospedale Del Mare, Napoli, Italy. 21 eparment of Medical Oncology, AORN “A. Cardarelli”, Naples, Italy Purpose/Objective: The management of oligoprogressive renal cell carcinoma (RCC) remains heterogeneous, particularly regarding the integration of stereotactic radiotherapy (SBRT) into systemic treatment pathways. The AI- assisted Delphi Consensus 2025 aimed to define multidisciplinary strategies for RCC, emphasizing areas of uncertainty related to local therapy and oligoprogression. Material/Methods: Forty-one Italian experts in RCC, predominantly medical oncologists (70%), with urologists and radiation oncologists represented, participated in a two-round Delphi process supported by the Butterfly Decisions AI platform. Forty-four statements across five thematic domains were analyzed through algorithmic consensus quantification (Certainty Index, Contradiction Index), with iterative refinement between sessions. The present analysis focuses on statements concerning SBRT and oligoprogressive
cancer patients treated between 2010 and 2024 for lymph-nodal or bone oligometastases, either during ongoing systemic therapy or prior to the initiation of androgen deprivation therapy (ADT). Toxicities were graded according to the RTOG criteria. Local Control (LC), Disease-Free Survival (DFS), and Overall Survival (OS) were analyzed. Post-SBRT imaging classified patients as complete responders (CRs) or non- complete responders (Not-CRs). Results: The median patient age was 72 years (range: 50–90). Ninety-two patients had lymph-nodal metastases and sixty-three had bone oligoprogressive lesions. SBRT was delivered with a median total dose of 24 Gy (range: 12–57 Gy). Median follow-up was 23 months (range: 1–95). Complete response was achieved in 84 patients (54%).LC rates were 97.3% and 93.5% at 12 and 24 months, respectively. DFS rates were 69% and 40.4%, while OS rates were 95.4% and 86.9% at the same time points.Subgroup analysis demonstrated a significant OS benefit in the CR group (p = 0.04), with 12- and 24-month OS rates of 100% and 92.4%, compared to 90% and 76.9% in the Not-CR group (Fig. 1). LC was also higher among CRs (98.7% and 97% at 12 and 24 months) compared to Not-CRs (93.6% and 81.6%, p = 0.14). No grade ≥ 3 toxicities were observed. Conclusion: SBRT represents an effective and well-tolerated option for patients with oligometastatic prostate cancer, providing excellent local control and favorable survival outcomes with negligible severe toxicity. Achieving a complete response after SBRT correlated with significantly improved overall survival, exceeding 90% at 2 years. Keywords: SBRT, Oligometastases, Prostate Oligoprogressive Renal Cell Carcinoma: When Medical Oncologists Vote on Radiotherapy : Insights from the AI-assisted Italian Delphi Consensus Giulia Marvaso 1,2 , Brigida Maiorano 3 , Francesco Massari 4 , Massimo Di Maio 5 , Roberto Iacovelli 6 , Sebastiano Buti 7 , Luca Tagliaferri 8 , Matteo Muto 9 , Marilena Di Napoli 10 , Vincenza Conteduca 11 , Marco Maruzzo 12 , Roberto Filippi 13 , Luigi Formisano 14 , Umberto Capitanio 15 , Matteo Santoni 16 , Sabrina Rossetti 17 , Riccardo Campi 18 , Maria Giuseppa Vitale 19 , Davide Bosso 20 , Sarah Scagliarini 21 1 Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy. 2 Radiotherapy Division, IRCCS European Institute of Oncology, Milan, Italy. 3 Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy. 4 Medical Oncology,, IRCCS Azienda Ospedaliero-Universitaria di Bologna,, Digital Poster Highlight 2756
disease. Results:
While consensus was robust for surgical and systemic domains (agreement >90%), the radiotherapy-related and oligoprogression statements generated the lowest stability, with agreement ranging from 67% to 75% and
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