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Unplanned radiotherapy (RT) breaks lengthen the overall treatment time and have a negative effect on local control and cure rates. Here, we report the results of a recent nationwide study providing data on the main causes of radiation therapy interruptions and management strategies to reduce or eliminate their clinical impact.

Italian RT center directors participated in a study that investigated RT weekly schedules, the handling of RT interruptions, and guidelines use for handling interruptions.

The survey was completed by 104 (56.8%) centers. With 2 (range 1-6) LINACS on average, only 5% of centers routinely conduct clinical activities six days a week; 22% of centers do so when dosage recovery is required; the remaining (73%) centers conduct clinical activities five days a week. The vast majority (93.1%) of centers considered interruptions a critical issue to manage, particularly for head and neck, cervix, lung and rectal cancer treatments. For 74% of respondents a 5-day or longer interruption could have an impact on the outcome of RT. The Royal College of Radiologists' international standards for interruption management were followed by 30 centers (28.88%), whereas 25 centers (24%) had their own set of rules. LINAC breakdowns (52%), toxicity (23%) and patient compliance (13%) were cited as the most frequent interruption causes. In the event of a LINAC breakdown, 80 centers have stated that patients will be treated in the other without recalculating the second machine.

The majority of centers (86%) recover lost doses by raising the overall dose (79%), treating patients on Saturday (34%), holding two sessions per day (18%), using an accelerated regimen in the final part of the treatment (17%). Only 28 centers (27%) consistently recover dosage.

The nationwide survey revealed a variety of approaches to recovering from RT disruption, emphasizing the necessity of national rules and company advice.