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Vienna, Austria

ESTRO 2023

Session Item

Monday
May 15
16:30 - 17:30
Plenary Hall
Reirradiation
Arnaud Beddok, France;
Giulio Francolini, Italy
Proffered Papers
Clinical
17:00 - 17:10
Re-irradiation in clinical practice: international patterns of care survey endorsed by ESTRO/EORTC
Jonas Willmann, Switzerland
OC-0918

Abstract

Re-irradiation in clinical practice: international patterns of care survey endorsed by ESTRO/EORTC
Authors:

Jonas Willmann1, Ane L Appelt2, Panagiotis Balermpas3, Brigitta G Baumert4, Dirk de Ruysscher5, Morten Hoyer6, Coen Hurkmans7, Orit Kaidar-Person8, Icro Meattini9, Maximilian Niyazi10, Philip Poortmans11, Nick Reynaert12, Yvette van der Linden13, Carsten Nieder14, Nicolaus Andratschke3

1Paul Scherrer Institute, Center for Proton Therapy, Villigen, Switzerland; 2University of Leeds, Leeds Institute of Medical Research at St James’s, Leeds, United Kingdom; 3University Hospital Zurich, Department of Radiation Oncology, Zurich, Switzerland; 4Cantonal Hospital Graubünden, Institute of Radiation-Oncology, Chur, Switzerland; 5Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), Maastricht, The Netherlands; 6Aarhus University Hospital, Danish Centre for Particle Therapy, Aarhus, Denmark; 7Catharina Hospital Eindhoven, Department of Radiation Oncology, Eindhoven, The Netherlands; 8Sheba Medical Center, Breast Cancer Radiation Therapy Unit, Ramat Gan, Israel; 9Azienda Ospedaliero Universitaria Careggi, Radiation Oncology Unit, Oncology Department, Florence, Italy; 10University Hospital, LMU Munich, Department of Radiation Oncology, , Munich, Germany; 11Iridium Netwerk, Department of Radiation Oncology, Wilrijk-Antwerp, Belgium; 12Institut Jules Bordet, Department of Medical Physics, Brussels, Belgium; 13Leiden University Medical Centre, Department of Radiotherapy, Leiden, The Netherlands; 14Nordland Hospital Trust, Department of Oncology and Palliative Medicine, Bodø, Norway

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Purpose or Objective

The use of re-irradiation is increasing, propelled by the introduction of new radiation therapy (RT) techniques. However, high-level evidence to guide clinical practice is scarce. Thus, we investigated international patterns of care of re-irradiation (reRT), presenting hereby the thoracic indications.

Material and Methods

We conducted an online survey from March to September 2022. The survey was endorsed by the European Organisation for Radiotherapy and Oncology (ESTRO) and the European Organisation for Research and Treatment of Cancer (EORTC) and distributed to radiation/clinical oncologists, as well as on social media (e.g., Twitter). The survey was split into five sections according to anatomical regions. Participants answered the sections matching their clinical focus. Each section included 14 multiple-choice questions, covering distinct parts of the reRT workflow, including indications, planning & delivery techniques, and follow-up. Percentages in the following refer to the total number of participants answering each question.

Results

The survey was completed by 371 respondents from 55 countries on 6 continents (Figure 1). Most respondents were from Italy (n=37, 10%), Spain (n=27, 7%), Germany (n=24, 6%) and the Netherlands (n=23, 6%). The median years of experience in radiation oncology were 17 (range 2-46). Most respondents (n=224, 60%) were affiliated with University Hospitals.
Brain (78%), pelvis (66%) and the head and neck region (64%) were the most commonly treated anatomical regions (Figure 2A). The vast majority of respondents did not have institutional guidelines for re-irradiation (range among anatomical regions: 16-18%) (Figure 2B). After re-irradiation, most have their patients primarily followed-up by a radiation oncologist, with standard follow-up per the respective disease (range among anatomical regions: 54-70%) (Figure 2C). Follow-up schedules specific for re-irradiation are uncommon (range among anatomical regions: 6-8%)


Conclusion

Re-irradiation is applied in all anatomical regions - most frequently in the brain, pelvis and head and neck region. However, most departments do not have internal guidelines, likely reflecting the lack of standardization and high-quality evidence to inform clinical practice. While re-irradiation specific follow-up is uncommon, in most practices patients are followed-up primarily by a radiation oncologist, which may be beneficial to assess the response to and potential side effects of re-irradiation.