Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology · 2025
Efficacy and safety of twice-daily accelerated hyperfractionated re-irradiation for thoracic malignancies.
СтатьяПоддержка исследования: вне правительства СШАПоддержка NIH: внешняя программаНазвание и аннотация: Перевод пока не подготовлен
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Doss Victoria L, de Sousa Cecilia F P M, Hales Elaina, Trent Tinker, Hagan Esi, Gebre Tsion, Obaideen Anas, Negassa Meti, Liu Dezhi, Hu Chen, Viswanathan Akila N, Li Heng, Voong K Ranh, Jia Xun, McNutt Todd, Ger Rachel B, Hales Russell K
Аннотация
INTRODUCTION: Balancing the demands for dose-escalated re-irradiation with toxicity to organs at risk (OARs) is a challenge. Twice-daily (BID) accelerated hyperfractionated re-irradiation (re-RT) is a potential solution, yet there is no guidance for its application for thoracic malignancies.
METHODS: All BID thoracic re-RT cases at our institution since 2014 were reviewed. Prior radiation courses were deformably registered. Summary plan dosimetrics were extracted using per-voxel cumulative EQD2 (α/β = 3 for normal tissues). Maximum toxicity following BID re-RT was graded per CTCAE v5.0 and assessed for relationship to radiation. Local failure (LF), progression-free survival (PFS), and overall survival (OS) were measured and compared between subgroups based on histology, re-RT dose, and metastatic status.
RESULTS: Sixty-four BID re-RT cases delivering at least 45 Gy in 30 fractions were reviewed. Fifty-eight patients (90.6 %) received a prior definitive course of radiation. The median first course EQD2 (α/β = 10) was 60.2 Gy. Median follow-up after re-RT was 14.2 months. Median OS was 18.5 months from completion of BID re-RT, and 59.0 % of patients had sustained local control at two years. Ten patients (15.6 %) experienced grade ≥3 toxicity. There were no grade 4 toxicities. There was one grade 5 event possibly attributable to re-RT. Of 24 OAR doses exceeding American Radium Society (ARS) and American College of Radiology (ACR) cumulative dose recommendations for re-RT, one case was associated with grade ≥3 toxicity.
CONCLUSIONS: Accelerated hyperfractionated BID re-RT is safe and effective for thoracic re-RT, providing durable local control and favorable survival outcomes with acceptable toxicity.
METHODS: All BID thoracic re-RT cases at our institution since 2014 were reviewed. Prior radiation courses were deformably registered. Summary plan dosimetrics were extracted using per-voxel cumulative EQD2 (α/β = 3 for normal tissues). Maximum toxicity following BID re-RT was graded per CTCAE v5.0 and assessed for relationship to radiation. Local failure (LF), progression-free survival (PFS), and overall survival (OS) were measured and compared between subgroups based on histology, re-RT dose, and metastatic status.
RESULTS: Sixty-four BID re-RT cases delivering at least 45 Gy in 30 fractions were reviewed. Fifty-eight patients (90.6 %) received a prior definitive course of radiation. The median first course EQD2 (α/β = 10) was 60.2 Gy. Median follow-up after re-RT was 14.2 months. Median OS was 18.5 months from completion of BID re-RT, and 59.0 % of patients had sustained local control at two years. Ten patients (15.6 %) experienced grade ≥3 toxicity. There were no grade 4 toxicities. There was one grade 5 event possibly attributable to re-RT. Of 24 OAR doses exceeding American Radium Society (ARS) and American College of Radiology (ACR) cumulative dose recommendations for re-RT, one case was associated with grade ≥3 toxicity.
CONCLUSIONS: Accelerated hyperfractionated BID re-RT is safe and effective for thoracic re-RT, providing durable local control and favorable survival outcomes with acceptable toxicity.