Policies for reirradiation of recurrent high-grade gliomas: a survey among Italian radiation oncologists.
OBJECTIVE
To assess the contribution of Italian radiation oncologists in the current management of recurrent high-grade gliomas (HGG), focusing on a reirradiation (reRT) approach.


METHODS
In 2015, the Reirradiation and the Central Nervous System Study Groups on behalf of the Italian Association of Radiation Oncology (AIRO) proposed a survey. All Italian radiation oncologists were individually invited to complete an online questionnaire regarding their clinical management of recurrent HGG, focusing on a reRT approach.


RESULTS
A total of 37 of 210 questionnaires were returned (18% of all centers): 16 (43%) from nonacademic hospitals, 14 (38%) from academic hospitals, 5 (13%) from private institutions, and 2 (6%) from hadron therapy centers. The majority of responding centers (59%) treated ≤5 cases per year. Performance status at the time of recurrence, along with a target diameter <5 cm and an interval from primary radiation ≥6 months, were the prevalent predictive factors considered for reRT. Sixty percent of reirradiated patients had already received a salvage therapy, either chemotherapy (40%) or reoperation (20%). The most common approach for reRT was fractionated stereotactic radiotherapy to a mean (photon) dose of 41.6 Gy.


CONCLUSIONS
Although there were wide variations in the clinical practice of reRT across the 37 centers, the core activities were reasonably consistent. These findings provide a basis for encouraging a national collaborative study to develop, implement, and monitor the use of reRT in this challenging clinical setting.
1 Radiation Oncology, Centro di Riferimento Oncologico, Aviano (Pordenone) - Italy.
Carlo
C
Furlan
2 Radiation Oncology, Azienda Ospedaliera San Camillo-Forlanini, Rome - Italy.
Stefano
S
Arcangeli
1 Radiation Oncology, Centro di Riferimento Oncologico, Aviano (Pordenone) - Italy.
Michele
M
Avanzo
3 Radiation Therapy, Presidio Ospedaliero San Filippo-Neri, Rome - Italy.
Maria A
MA
Mirri
4 Radiation Therapy, Ospedale di Aosta, Aosta - Italy.
Fernando
F
Munoz
5 Radiation Therapy, Ospedale di Sanremo, Sanremo (Imperia) - Italy.
Stefania
S
Giudici
6 Radiation Therapy, Ospedale Casa Sollievo della Sofferenza, Foggia - Italy.
Antonio
A
Perrone
7 Proton Therapy, Azienda Provinciale per i Servizi Sanitari, Trento - Italy.
Dante
D
Amelio
8 Radiation Oncology, Ospedale Santa Chiara, Trento - Italy.
Luigi
L
Tomio
9 Radiation Oncology, Azienda Ospedaliera Santa Maria, Terni - Italy.
Loredana
L
Draghini
10 Radiation Oncology, Ospedale San Raffaele, IRCCS, Milan - Italy.
Aniko M
AM
Deli
11 Radiation Therapy, Ospedale Santa Maria della Misericordia, Rovigo - Italy.
Giovanni
G
Pavanato
12 Radiation Therapy, Emicenter-Casavatore, Napoli - Italy.
Francesca M
FM
Giuliano
13 Radiation Therapy, Università degli Studi di Messina, Messina - Italy.
Antonio
A
Pontoriero
14 Radiation Therapy, Arcispedale degli Studi Santa Maria Nuova-IRCCS, Reggio Emilia - Italy.
Patrizia
P
Ciammella
15 Radiation Therapy, Istituto Humanitas Cancer Center and Research Hospital, Milan - Italy.
Pierina
P
Navarria
16 Radiotherapy and Radiosurgery, Istituto CNAO (Centro Nazionale Adroterapia Oncologica), Pavia - Italy.
Alberto
A
Iannalfi
17 Radiation Therapy, Spedali Civili-Università di Brescia, Brescia - Italy.
Michela
M
Buglione
18 Radiation Therapy, Azienda Ospedaliera San Giuseppe Moscati, Avellino - Italy.
Cesare
C
Guida
19 Radiation Therapy, Policlinico S-Orsola-Malpighi, Bologna - Italy.
Silvia
S
Cammelli
20 Radiation Therapy, Studio di Radiologia Prof. V. Muto, Napoli - Italy.
Vincenzo
V
Iorio
21 Radiation Therapy, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona - Italy.
Massimo
M
Cardinali
22 Radiation Therapy, Azienda Ospedaliero-Universitaria Policlinico SS. Annunziata, Chieti - Italy.
Domenico
D
Genovesi
23 Radiation Therapy, Ospedale Sant'Anna, Como - Italy.
Lucia
L
Barsacchi
24 Radiation Therapy, Policlinico Agostino Gemelli, Rome - Italy.
Mario
M
Balducci
25 Radiation Therapy, Presidio Ospedaliero Campo di Marte, Lucca - Italy.
Rita
R
Bagnoli
26 Radiation Therapy, Istituto Oncologico Veneto, Padova - Italy.
Franco
F
Berti
27 Radiation Therapy, Azienda Ospedaliera-Università degli Studi di Perugia, Perugia - Italy.
Giampaolo
G
Montesi
28 Radiation Oncology, Azienda Ospedaliera Universitaria Pisana, Pisa - Italy.
Francesco
F
Pasqualetti
29 Radiation Therapy, Azienda Ospedaliera Sant'Andrea, Rome - Italy.
Paolo
P
Bonome
30 Radiation Oncology, Policlinico Tor Vergata, Rome - Italy.
Riccardo
R
Santoni
31 Radiation Therapy, Ospedale di Circolo-Fondazione Macchi, Varese - Italy.
Daniela
D
Doino
32 Radiation Therapy, Ospedale dell'Angelo di Mestre, Venezia - Italy.
Patrizia
P
Schirru
33 Radiation Therapy, Istituto Neurologico IRCCS Fondazione Carlo Besta, Milan - Italy.
Valentina
V
Pinzi
34 Radiation Therapy, Istituto Nazionale per lo Studio e la Cura dei Tumori - Fondazione "G. Pascale", Napoli - Italy.
Valentina
V
Borzillo
35 Radiation Therapy, Ospedale Ca' Foncello di Treviso, Treviso - Italy.
Fabio
F
Ferrarese
36 Radiation Therapy, Fondazione di Ricerca e Cura "Giovanni Paolo II", Campobasso - Italy.
Marica
M
Ferro
37 Radiation Therapy, Ospedale di Circolo di Busto Arsizio, Busto Arsizio (Varese) - Italy.
Luigi De
L
Cicco
38 Radiation Therapy, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara - Italy.
Marco
M
Krengli
39 Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Firenze - Italy.
Silvia
S
Scoccianti
2 Radiation Oncology, Azienda Ospedaliera San Camillo-Forlanini, Rome - Italy.
Vittorio
V
Donato
D000293:Adolescent; D003131:Combined Modality Therapy / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D005910:Glioma / Q000532:radiotherapy*; D006801:Humans; D007558:Italy; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D000072378:Radiation Oncologists / Q000706:statistics & numerical data*; D000069475:Re-Irradiation / Q000592:standards* / Q000706:statistics & numerical data*; D016879:Salvage Therapy / Q000592:standards / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
Dose; Glioblastoma; Glioma; IMRT; Radiosurgery; Reirradiation