Handling Increasing Reirradiation Cases: What’s Your Plan?

Reirradiation in Today’s Clinics

Reirradiation—a new course of radiotherapy to a previously irradiated volume or where the cumulative dose raises concerns of toxicity¹—is a growing challenge for Radiation Oncology providers. Rising cancer survival rates and longer life expectancies are bringing patients back to the clinic for retreatment in greater numbers. The expansion of global healthcare access allows patients to present for treatment and retreatment at multiple facilities, scattering their data far and wide.

Historically, these types of cases were considered outliers, but today, clinics see an average reirradiation caseload of 10-20%.²

Challenges in the Reirradiation Process 

When a patient presents for reirradiation, it can be complicated to create a timely, comprehensive, and accurate assessment that accounts for their complete radiation history. Faced with multiple factors and a barrage of information, current treatment planning systems (TPS) are struggling to address some major challenges presented with these types of cases. 

Where is the RT data from the previous treatment(s) located? 

A reirradiation patient is often treated at another clinic and their plan is created by a different TPS. Locating the patient’s RT data and bringing it into your TPS needs to be done efficiently and securely. Relying on screenshots sent through email should be a thing of the past.

Can I bring this RT data into my current TPS? 

Many of today's systems are not equipped to import and handle RT data created from another system. Because of these limitations, clinicians must rely on limited information which does not give confidence in an accurate assessment.

How do I use this RT data to create a comprehensive, accurate assessment efficiently? 

Once RT data is collected, creating a comprehensive and accurate assessment of the prior treatment on today's anatomy becomes a top priority, but is often difficult with the current systems registration abilities. Similarly, equating different types of treatments and fractionations is difficult and inefficient with today's systems.

How do I share the assessment with my colleagues?

Colleagues in your clinic need to understand the patient’s full reirradiation history in order to effectively treat the patient. It’s important that they see what steps were taken to create the 

assessment that they are viewing. Oftentimes, with today’s TPS, this prior work is unclear. Most clinics don’t have the capability to produce an automatic summary report that includes all relevant information, such as previous radiation history, dose distribution, and cumulative BED/EQD2.

Simplifying the Reirradiation Process

With a growing volume and complexity of reirradiation cases comes a growing need for standardization and efficiency. A new solution is needed to simplify the reirradiation process and bring patients from simulation to treatment in less time and with more accuracy. In short, this solution should:

• Provide a secure, efficient way to gather RT data and not force you to settle for screenshots.

• Be vendor agnostic and able to import data created from any TPS.

• Be able to accurately and efficiently register images in a variety of clinical scenarios so the transferred dose on today’s anatomy is accurate.

• Equate different types of treatments and fractionations accurately and efficiently.

• Show the work previously performed to create the assessment for easy colleague review.

Planning for increased reirradiation volume is becoming critically important. With a robust solution, you can ensure accuracy and efficiency when treating patients with multiple plans and different treatment types. An improved solution that summarizes all relevant information will increase safety and accuracy, reduce planning time, support streamlined collaboration with the treatment team, and ensure better outcomes for patients. 

Does your clinic have a plan?

Footnotes

1. Nicolaus Andratschke, MD, et al., “European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus on re-irradiation: definition, reporting, and clinical decision making,” The Lancet Oncology Volume 23, Issue 10 (October 2022): https://doi.org/10.1016/S1470-2045(22)00447-8.
   
   
2. Based on a survey of MIM^® users at the 2022 ASTRO Annual Meeting.