A surveillance study of the current status of reirradiation and patterns of practice

Abstract

The aim of this study was to survey the current status of reirradiation (Re-RT) and patterns of practice in Japan. An email questionnaire was sent to Kansai Cancer Therapist Group partner institutions, using questions similar to those in the Canadian radiation oncologist (RO) survey (2008). A total of 34 ROs from 28 institutions returned the survey. All 28 institutions experienced Re-RT cases in 2014. However, 26 of the 28 institutions (93%) reported difficulty in obtaining Re-RT case information from their respective databases. Responses from 19 institutions included the number of Re-RT cases; this rose from 183 in the period 2005–2009 (institution median = 4; 2–12.9) to 562 in the period 2010–2014 (institution median = 26; 2–225). Important considerations for indication of Re-RT were age (65%), performance status (83%), life expectancy (70%), absence of distant metastases (67%), and interval since previous treatment (73%). Previous total radiation dose (48%), volume of tissue irradiated (72%), and the biologically equivalent dose (BED; 68.5%) were taken into account during Re-RT planning. These factors were similar to those considered in the Canadian survey; however, the present study did not consider age. In eight site-specific scenarios, barring central nervous system recurrence, more than 90% of ROs agreed to perform Re-RT, which was higher than the percentage observed in the Canadian survey. Re-RT cases have increased in number and aroused interest among ROs in this decade of advanced technology. However, consensus building to establish guidelines for the practice and prospective evaluation of Re-RT is required.

A surveillance study of patterns of reirradiation practice using external beam radiotherapy in Japan

“…Responses to the site-specific questions are summarized in Table 5 . In general, >60% of the ROs recommended Re-RT for every scenario, which was similar to the trend observed in the Kansai survey [ 4 ].…”

“…Of the total respondents, 48% had been in practice for >20 years, whereas 2% had been in practice for <5 years. More experienced physicians replied to this questionnaire than to the previous 2017 Kansai survey ( Table 2 ) [ 4 ]. Respondents were asked to comment on patient factors that would influence their decision to recommend Re-RT.…”

“…Part 2 (for individual ROs) included indications and treatment planning for Re-RT and eight case scenarios selected from the most common tumor types (head and neck, chest, colorectal, genitourinary, gynecologic, gastrointestinal) reported in the 2008 Canadian survey and the Kansai survey [ 4 ]. The completed questionnaires were received via e-mail responded to JASTROgram.…”

“…Unfortunately, there is limited high-level evidence supporting the use of Re-RT; therefore, radiation oncologists (RO) make clinical decisions regarding Re-RT based mainly on their own experiences and knowledge of the patient’s general health condition and preferences. To reduce this burden, we conducted a survey of Re-RT patterns of practice in the Kansai district of Japan in 2017 [ 4 ] and compared the results with those from a 2008 Canadian survey to examine changes across decades and between countries [5]. To continue this effort, we conducted a nationwide surveillance study in Japan to determine Re-RT patterns of practice for cases of in-field cancer recurrence after previous RT.…”

Number of radiotherapy treatment machines in the population and cancer mortality: an ecological study

“…Computation might underestimate the need, especially in high-income countries where disease progression/recurrence and retreatment are of increasing clinical relevance. 28 Focusing on Europe, Rosenblatt et al 29 described unmet needs for RTMs in several countries (again based on incident cases), which might eventually result in an adverse survival prospect when our results are considered.…”