A comprehensive national audit of radiotherapy retreatment numbers, sites and indications

Authors

  • Morten Nielsen Department of Oncology, Odense University Hospital, Odense, Denmark https://orcid.org/0000-0001-5819-5240
  • Mai-Britt Linaa Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
  • Vibeke Nordmark Hansen Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK https://orcid.org/0000-0003-2347-9977
  • Laura Patricia Kaplan Department of Oncology and Palliative Units, Zealand University Hospital, Næstved, Denmark https://orcid.org/0000-0002-5761-9950
  • Mikkel Drøgemüller Lund Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark https://orcid.org/0000-0001-9182-8185
  • Martin Skovmos Nielsen Department of Oncology & Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark https://orcid.org/0000-0002-3955-7266
  • Wiviann Ottoson Department of Oncology, Radiotherapy Research Unit, Copenhagen University Hospital – Herlev and Gentofte, Herlev, Denmark https://orcid.org/0000-0002-7167-0007
  • Cécile Peucelle Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
  • Laura Ann Rechner Department of Oncology, Radiotherapy Research Unit, Copenhagen University Hospital – Herlev and Gentofte, Herlev, Denmark https://orcid.org/0000-0002-0623-4495
  • Heidi S. Rønde Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark https://orcid.org/0000-0002-2736-8433
  • Tine Schytte Department of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark https://orcid.org/0000-0002-6705-1561
  • Weronika Maria Szejniuk Department of Oncology & Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark https://orcid.org/0000-0001-6790-6710
  • Rebecca Jean Tobin Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
  • Lone Hoffmann Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark https://orcid.org/0000-0002-3575-0421
  • Ane Appelt Leeds Institute of Medical Research, University of Leeds, Leeds, UK https://orcid.org/0000-0003-2792-9218

DOI:

https://doi.org/10.2340/1651-226X.2025.43825

Keywords:

Reirradiation, repeat irradiation, retreatment, radiotherapy, national audit

Abstract

Background and purpose: Reirradiation has seen increased interest and clinical use; however, robust data on patient numbers and treatment indications are missing. As a precursor to a prospective national reirradiation registry, a comprehensive national audit of reirradiation was performed.

Patients/materials and methods: Radiotherapy retreatment courses in 2023 were audited by all (eight) radiotherapy centres in Denmark. Six centres extended the evaluation to include 2021–22, and three of these also evaluated preceding years. Reirradiation was defined according to the ESTRO/EORTC consensus (i.e. treatment volume overlap or cumulative dose toxicity risk) using 3 months threshold between the primary and reirradiation courses. Reirradiation courses were further stratified into curative/ablative and palliative treatments by prescription dose.

Results: The total number of radiotherapy patients at Danish centres in 2023 was 17,424. Of these, 3,163 received retreatment, including 1,471 reirradiation courses (1,035 palliative; 436 curative/ablative). From 2014 to 2023, absolute numbers for both retreatment and reirradiation increased. We found large variation in prescription doses and fractionation schedules used for reirradiation. Widely used palliative prescriptions were 8Gy/1 fraction (F), 20Gy/4F and 30Gy/10F; stereotactic prescriptions of 20Gy/1F or 27Gy/3F in brain and 45Gy/3F in lung; and a variety of curative treatments schedules. Palliative reirradiations were primarily thoracic (29%), spine (25%), and abdominal/pelvic (22%) and curative/ablative reirradiations were primarily breast (29%) and lung stereotactic (23%).

Interpretation: This is the first comprehensive national audit of reirradiation, demonstrating an increasing number of patients being treated, using a wide variety of dose prescriptions and fractionation schedules.

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Published

2025-07-09

How to Cite

Nielsen, M., Linaa, M.-B., Hansen, V. N., Kaplan, L. P., Lund, M. D., Nielsen, M. S., … Appelt, A. (2025). A comprehensive national audit of radiotherapy retreatment numbers, sites and indications. Acta Oncologica, 64, 872–878. https://doi.org/10.2340/1651-226X.2025.43825

Issue

Vol. 64 (2025): Acta Oncologica

Section

Original article

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Copyright (c) 2025 Morten Nielsen, Mai-Britt Linaa, Vibeke Nordmark Hansen, Laura Patricia Kaplan, Mikkel Drøgemüller Lund, Martin Skovmos Nielsen, Wiviann Ottoson, Cécile Peucelle, Laura Ann Rechner, Heidi S. Rønde, Tine Schytte, Weronika Maria Szejniuk, Rebecca Jean Tobin, Lone Hoffmann, Ane Appelt

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This work is licensed under a Creative Commons Attribution 4.0 International License.