ESTRO 2023

Session Item

Monday

May 15

16:30 - 17:30

Plenary Hall

Reirradiation

Co-Chair: Arnaud Beddok, France;

Chair: Giulio Francolini, Italy

Session Code: 3460

Session Type: Proffered Papers

Track: Clinical

17:00 - 17:10

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

Jonas Willmann, Switzerland

Presentation Number: OC-0918

Abstract

Abstract Title:

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.