KEY POINTS
- This national web-based survey included 23 radiation oncologists from 18 of 21 Dutch radiotherapy centres, assessing non-operative radiotherapy practice for unresectable locally recurrent rectal cancer.
- The most common reported treatment modalities were radiotherapy (83%) and chemoradiotherapy (61%); 57% of respondents reported no local radiotherapy protocol or guideline for definitive or palliative treatment in this setting.
- Indications were highly consistent: symptomatic relief was reported by 100%, improvement of quality of life by 83%, and prevention of locoregional complaints by 44%.
- Dose schedules varied substantially. In radiotherapy-naïve patients, common regimens included 5 × 5 Gy and 25 × 2 Gy with concomitant capecitabine; in previously irradiated patients, 15 × 2 Gy with concomitant capecitabine and 5 × 4 Gy predominated.
- Follow-up was not standardized for 57% of respondents, and variation was also reported within the same centres for protocols, bladder filling, dose schedules, CTV margins, α/β ratios, response evaluation, and follow-up.
CLINICAL TAKEAWAY
This survey shows that non-operative radiotherapy for unresectable locally recurrent rectal cancer remains a poorly standardized area, even within a relatively centralized national radiotherapy system. The main practical message is not that one regimen is superior, but that dose, delineation, response assessment, and follow-up vary widely because evidence and dedicated guidelines are limited. This is worth attention as a practice-pattern signal and a rationale for prospective registration, quality assurance, patient-reported outcomes, and consensus recommendations.