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.