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Current clinical practice of radiotherapy for the non-operative treatment of patients with unresectable locally recurrent rectal cancer: results of a national survey of the dutch society for radiotherapy and oncology
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DOI：10.1186/s13014-026-02890-1.png)
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Abstract
En 中文
Over half of patients with locally recurrent rectal cancer (LRRC) are ineligible for curative-intent multimodality treatment, typically including neoadjuvant treatment followed by surgery, due to unresectable disease, distant metastases, and/or frailty. Non-operative management for unresectable LRRC may include (chemo)(re-)irradiation, but evidence remains scarce. This study explores the current clinical practice of radiotherapy for LRRC in the Netherlands within this setting. A web-based survey was designed and distributed to members of the Dutch Society of Radiation Oncology between December 2024 and February 2025. The survey comprised 28 items, addressing clinical indications, target delineation, treatment planning, dose and fractionation, radiotherapy techniques and knowledge gaps in current clinical practice. 23 radiation oncologists from 18 out of 21 Dutch institutes completed the survey. While agreement existed regarding indications for radiotherapy in the non-operative management for LRRC, marked variability was observed in dose and fractionation schedules and target volume delineation. There seemed to be no consensus on response evaluation or follow-up schedules. Reported clinical challenges included patient heterogeneity, absence of evidence-based guidelines, limited knowledge on radiation-induced toxicity, difficulties estimating prognosis and management of therapy-resistant symptoms. This national survey highlights the clinical heterogeneity and lack of consensus regarding radiotherapy for unresectable LRRC. Variations in dose and fractionation schedules, target volume delineation and follow-up underscore the need for prospective studies. Future research initiatives should prioritize optimal dose and fractionation schedules and the role of dose escalation, while integrating quality assurance programs and patient-reported outcomes to guide development of evidence-based recommendations for this complex patient group.
Keywords:
Radiotherapy
Locally recurrent rectal cancer
Symptom control
Palliation
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