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)

• Rossella Di Franco ^[3] ; Donato Pezzulla ^[4] ; Fabio Arcidiacono ^[5] ; Antonio Pontoriero ^[6] ; Francesco Cellini ^[7] ; Liliana Belgioia ^[1] ; Valentina Borzillo ^[3] ; Sara Lillo ^[2] ; Francesco Pastore ^[8] ; Luca Dominici ^[9] ; Silvia Longo ^[7] ; Alberto Cacciola ^[6] ; Antonella Ciabattoni ^[10] ; Alice Zamagni ^[11] ; Giulio Francolini ^[12] ; Antonella Fontana ^[13] ; Esmeralda Scipilliti ^[3] ; Rosario Mazzola ^[14] ; Elisa DAngelo ^[15] ; Rossana Ingargiola ^[16] ; Paolo Muto ^[3] ; Ernesto Maranzano ^[17]
  1. [1] University of Genoa

     University of Genoa

     Genoa, Italia

     
  2. [2] University of Messina

     University of Messina

     Mesina, Italia

     
  3. [3] Department of Radiation Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
  4. [4] Radiation Oncology Unit, Gemelli Molise Hospital–Università Cattolica del Sacro Cuore, Largo A. Gemelli 1, 86100, Campobasso, Italy
  5. [5] Radiotherapy Oncology Centre, “S. Maria” Hospital, Terni, Italy
  6. [6] Radiation Oncology Unit, A.O.U. “G. Martino”, Messina, Italy
  7. [7] Dipartimento di Diagnostica Per Immagini, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, Rome, Italy
  8. [8] Radiation Oncology, Emicenter, Naples, Italy
  9. [9] Department of Radiotherapy, Humanitas Clinical and Research Center–IRCCS, Rozzano, Milan, Italy
  10. [10] UOC Radioterapia, Ospedale San Filippo Neri, ASL Roma 1, Rome, Italy
  11. [11] Radiation Oncology, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum-Bologna University, Bologna, Italy
  12. [12] Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
  13. [13] UOC Radioterapia, Ospedale S.M. Goretti ASL di Latina, Latina, Italy
  14. [14] Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Negrar, Italy
  15. [15] UOC di Radioterapia Oncologica, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
  16. [16] Dipartimento di Radioterapia, Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
  17. [17] University of Perugia-Faculty of Medicine and Surgery, Radiotherapy Oncology Centre-“S. Maria” Hospital, Terni, Italy

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• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 25, Nº. 2 (February), 2023, págs. 408-416
• Idioma: inglés
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• Resumen

  • 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.