Re-irradiation in clinical practice: Results of an international patterns of care survey within the framework of the ESTRO-EORTC E2-RADIatE platform

Jonas Willmann; Ane L Appelt; Panagiotis Balermpas; Brigitta G Baumert; Dirk de Ruysscher; Morten Hoyer; Coen Hurkmans; Orit Kaidar-Person; Icro Meattini; Maximilian Niyazi; Philip Poortmans; Nick Reynaert; Stephanie Tandini-Lang; Yvette van der Linden; Carsten Nieder; Nicolaus Andratschke

doi:10.1016/j.radonc.2023.109947

Re-irradiation in clinical practice: Results of an international patterns of care survey within the framework of the ESTRO-EORTC E²-RADIatE platform

Radiother Oncol. 2023 Dec:189:109947. doi: 10.1016/j.radonc.2023.109947. Epub 2023 Oct 6.

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, Stephanie Tandini-Lang³, Yvette van der Linden¹³, Carsten Nieder¹⁴, Nicolaus Andratschke³

Affiliations

¹ Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. Electronic address: Jonas.willmann@usz.ch.
² Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
³ Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁴ Institute of Radiation-Oncology, Cantonal Hospital Graubünden, Chur, Switzerland.
⁵ Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), School for Oncology and Developmental Biology (GROW), Maastricht and Department of Radiotherapy, Erasmus MC, Rotterdam, the Netherlands.
⁶ Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark.
⁷ Department of Radiation Oncology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands.
⁸ Breast Cancer Radiation Therapy Unit, Sheba Medical Center, Ramat Gan, Israel And Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
⁹ Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
¹⁰ Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany; Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany.
¹¹ Department of Radiation Oncology, Iridium Netwerk, Wilrijk-Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk-Antwerp, Belgium.
¹² Department of Medical Physics, Institut Jules Bordet, Brussels, Belgium.
¹³ Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands.
¹⁴ Department of Oncology and Palliative Medicine, Nordland Hospital Trust, Bodø, Norway; Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway.

PMID: 37806559
DOI: 10.1016/j.radonc.2023.109947

Abstract

Background: Re-irradiation is an increasingly utilized treatment for recurrent, metastatic or new malignancies after previous radiotherapy. It is unclear how re-irradiation is applied in clinical practice. We aimed to investigate the patterns of care of re-irradiation internationally.

Material/methods: A cross-sectional survey conducted between March and September 2022. The survey was structured into six sections, each corresponding to a specific anatomical region. Participants were instructed to complete the sections of their clinical expertise. A total of 15 multiple-choice questions were included in each section, addressing various aspects of the re-irradiation process. The online survey targeted radiation and clinical oncologists and was endorsed by the European Society for Radiotherapy and Oncology (ESTRO) and the European Organisation for Research and Treatment of Cancer (EORTC).

Results: 371 physicians from 55 countries across six continents participated. Participants had a median professional experience of 16 years, and the majority (60%) were affiliated with an academic hospital. The brain region was the most common site for re-irradiation (77%), followed by the pelvis (65%) and head and neck (63%). Prolonging local control was the most common goal (90-96% across anatomical regions). The most common minimum interval between previous radiotherapy and re-irradiation was 6-12 months (45-55%). Persistent grade 3 or greater radiation-induced toxicity (77-80%) was the leading contraindication. Variability in organs at risk dose constraints for re-irradiation was observed. Advanced imaging modalities and conformal radiotherapy techniques were predominantly used. A scarcity of institutional guidelines for re-irradiation was reported (16-19%). Participants from European centers more frequently applied thoracic and abdominal re-irradiation. Indications did not differ between academic and non-academic hospitals.

Conclusion: This study highlights the heterogeneity in re-irradiation practices across anatomical regions and emphasizes the need for high-quality evidence from prospective studies to guide treatment decisions and derive safe cumulative dose constraints.

Keywords: Patterns of care; Radiotherapy; Re-irradiation; Survey.

MeSH terms

Cross-Sectional Studies
Humans
Neoplasm Recurrence, Local / pathology
Prospective Studies
Radiotherapy, Conformal*
Re-Irradiation* / methods

Grants and funding

28832/CRUK_/Cancer Research UK/United Kingdom