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Reirradiation on spine metastases: an Italian survey on behalf of palliative care and reirradiation study groups of Italian association of radiotherapy and clinical oncology (AIRO)

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Abstract

Aim

This survey derived from the collaboration between the Palliative Care and Reirradiation Study Groups of the Italian Association of Radiotherapy and Clinical Oncology (AIRO). Its aim was to obtain a real “snapshot” on the treatments of spinal metastases, focusing on reirradiation, among radiation oncologists in Italy.

Methods

The survey was elaborated on SurveyMonkey’s online interface and was sent via e-mail to all Radiation Oncologists of AIRO that were invited to anonymously fill in the electronic form within 60 days. The questionnaire was prepared by the AIRO “Palliative care” and “Reirradiation” Study Groups and it consisted of 36 questions, 19 single-choice questions, 10 multiple-choice questions and 6 open questions. The data were analyzed and represented with tables and graphs.

Results

The survey shows that palliative radiotherapy remains a field of interest for most ROs in the Italian centers. 3D Conventional Radiation Therapy (3DCRT) alone or in combination with other techniques is the primary choice for patients with a life expectancy of less than 6 months. For patients with a life expectancy of more than six months, there is an increased use of new technologies, such as Volumetric Modulated Arc Therapy (VMAT). Factors considered for retreatment are time between first and second treatment, dose delivered to spine metastasis and spinal cord in the first treatment, vertebral stability, symptoms, and/or performance status. The most feared complication are myelopathy followed by vertebral fracture and local recurrence. This explain an increasing focus on patient selection and the use of high technology in the treatment of metastatic patients.

Conclusion

Stereotactic body radiotherapy (SBRT) and image-guided radiotherapy allow the administration of ablative RT doses while sparing the constraints of healthy tissue in spinal metastases. However, there is still an unclear and heterogeneous reality in the reirradiation of spinal metastases. A national registry with the aim of clarifying the most controversial aspects of vertebral metastasis retreatments will enable better management of these patients and design more targeted study designs.

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Abbreviations

AIRO:

Association of Radiotherapy and Clinical Oncology

cERBT:

Conventional external beam radiotherapy

re-RT:

Reirradiation

SBRT:

Stereotactic body radiotherapy

CTV:

Clinical Target Volume

PTV:

Planning Target Volume

ROs:

Radiation Oncologists

3DCRT:

3D Conventional Radiation Therapy

Dmax:

Maximal dose

BED:

Biological Equivalent Dose

GTV:

Gross Tumor Volume

VMAT:

Volumetric Modulated Arc Therapy

EQD2:

Equivalent total doses in 2-Gy fractions

OARs:

Organs at Risk

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Acknowledgements

The Authors thank the Scientifc Committee and Board of the AIRO for the critical revision and final approval of the manuscript (Nr.16/2022).

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy

    Rossella Di Franco, Valentina Borzillo, Esmeralda Scipilliti & Paolo Muto

  2. Radiation Oncology Unit, Gemelli Molise Hospital–Università Cattolica del Sacro Cuore, Largo A. Gemelli 1, 86100, Campobasso, Italy

    Donato Pezzulla

  3. Radiotherapy Oncology Centre, “S. Maria” Hospital, Terni, Italy

    Fabio Arcidiacono

  4. Radiation Oncology Unit, A.O.U. “G. Martino”, Messina, Italy

    Antonio Pontoriero & Alberto Cacciola

  5. Dipartimento di Diagnostica Per Immagini, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, Rome, Italy

    Francesco Cellini & Silvia Longo

  6. Department of Health Science (DISSAL), University of Genoa, Genoa, Italy

    Liliana Belgioia

  7. IRCCS Ospedale Policlinico San Martino, Genoa, Italy

    Liliana Belgioia

  8. Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy

    Sara Lillo

  9. Radiation Oncology, Emicenter, Naples, Italy

    Francesco Pastore

  10. Department of Radiotherapy, Humanitas Clinical and Research Center–IRCCS, Rozzano, Milan, Italy

    Luca Dominici

  11. UOC Radioterapia, Ospedale San Filippo Neri, ASL Roma 1, Rome, Italy

    Antonella Ciabattoni

  12. Radiation Oncology, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum-Bologna University, Bologna, Italy

    Alice Zamagni

  13. Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Giulio Francolini

  14. UOC Radioterapia, Ospedale S.M. Goretti ASL di Latina, Latina, Italy

    Antonella Fontana

  15. Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Negrar, Italy

    Rosario Mazzola

  16. UOC di Radioterapia Oncologica, Azienda Ospedaliero Universitaria di Modena, Modena, Italy

    Elisa D’Angelo

  17. Dipartimento di Radioterapia, Centro Nazionale di Adroterapia Oncologica, Pavia, Italy

    Rossana Ingargiola

  18. University of Perugia-Faculty of Medicine and Surgery, Radiotherapy Oncology Centre-“S. Maria” Hospital, Terni, Italy

    Ernesto Maranzano

Authors
  1. Rossella Di Franco
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  2. Donato Pezzulla
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  3. Fabio Arcidiacono
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  4. Antonio Pontoriero
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  5. Francesco Cellini
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  7. Valentina Borzillo
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  8. Sara Lillo
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  9. Francesco Pastore
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  10. Luca Dominici
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  11. Silvia Longo
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  12. Alberto Cacciola
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  14. Alice Zamagni
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  15. Giulio Francolini
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  16. Antonella Fontana
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  18. Rosario Mazzola
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  19. Elisa D’Angelo
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  20. Rossana Ingargiola
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  21. Paolo Muto
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  22. Ernesto Maranzano
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Contributions

DFR, PD, AF, BV, PA and CF: conception and design of the study and wrote the first draft of the manuscript. BL, LS, PF, DL, LS, CaA, CiA, ZA, FG, FA, SE, MR, D’AE, IR, MP, ME: data collection and wrote sections of the manuscript. DFR, PD, AF, CF, ME and BL: data analysis.

Corresponding author

Correspondence to Donato Pezzulla.

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Di Franco, R., Pezzulla, D., Arcidiacono, F. et al. Reirradiation on spine metastases: an Italian survey on behalf of palliative care and reirradiation study groups of Italian association of radiotherapy and clinical oncology (AIRO). Clin Transl Oncol 25, 408–416 (2023). https://doi.org/10.1007/s12094-022-02951-3

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