Managing unplanned radiotherapy interruptions in Italy: results from an AIRO survey

Background Radiation oncology (RO) is essential in cancer treatment. Unplanned interruptions reduce tumor control, yet no validated management guidelines exist. The Italian Association of Radiation and Clinical Oncology (AIRO) conducted a national survey to assess the prevalence, causes, and management strategies for RT interruptions across Italy. Methods This cross-sectional survey was conducted between April and June 2022. A 34-question survey was emailed to directors of all Italian ROT centers, covering: (1) demographic and institutional characteristics; (2) radiobiological knowledge of ROT interruptions; (3) clinical management and compensation strategies. Results A total of 104 centers responded. Respondents had a median age of 57 years (range 34–74), and most worked in General Hospitals (64%). Centers had a median of 2 LINACs (range 1–6), with 16% operating only one LINAC. 96% of radiation oncologists (Ros) considered ROT interruptions a critical issue, particularly in curative (51%) and adjuvant (29%) settings. 42% defined an interruption of > 5 days as critical, and 63% believed treatment phase did not influence impact. 29% of ROs followed formal guidelines [e.g., Royal College of Radiographers (RCR)]. The main causes of interruptions were LINAC breakdowns (22%), toxicity (22%), and patient compliance issues (22%). 24% of ROs followed codified procedures for managing interruptions; 84% regularly monitored treatment breaks. Dose recovery strategies: 28% always compensated, 59% occasionally compensated, primarily by increasing total dose (48%) or working on Saturdays (20%). Conclusion This study reveals variability in ROT interruption management, stressing the need for AIRO guidelines, collaboration, and modern radiobiological integration.