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.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [AA reports Institutional Research Collaboration Agreement between Leeds Teaching Hospitals NHS Trust and RaySearch Laboratories, which includes software development for re-irradiation as a specific area of collaboration. BGB is a member of the trial steering committee of the BRIOChe trial (Brain Re-Irradiation Or Chemotherapy: a phase II trial of re-irradiation or chemotherapy for recurrent glioblastoma). IM received honoraria for occasional attendance at advisory boards supported by Eli Lilly, Novartis, Pfizer, SeaGen, Gilead, Accuray. NA reports grants or contracts from ViewRay Inc., University of Zurich CRPP, Swiss National Fund, SAKK, EORTC, GHG, ESTRO, SRO, Swiss Cancer League, consulting fees from Brainlab AG, ViewRay Inc., AstraZeneca, honoraria from ViewRay Inc., AstraZeneca, participation on a Data Safety Monitoring Board or Advisory Board from AstraZeneca, leadership or fiduciary role in other boards, societies, committees in EORTC, GHG, SAKK, SRO. DR reports institutional financial interests (no personal financial interests) in the form of research grant/support/advisory board from AstraZeneca, BMS, Beigene, Philips, Olink, Eli-Lilly. All other authors report no conflicts of interest.].
(Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)