Technical innovations & patient support in radiation oncology · 2025
A prospective audit of thoracic reirradiation practice and peer-review in a high-volume academic center.
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Murphy Geraldine, Tong Daniel, Wu Grace, Cho B C John, Giuliani Meredith, Hope Andrew, Lok Benjamin H, Sun Alexander, Bissonnette Jean-Pierre, Bezjak Andrea
Аннотация
BACKGROUND: Reirradiation is an increasingly common challenge with limited prospective evidence to guide practice, which varies internationally. This paper presents the patterns of practice in thoracic reirradiation within a high-volume academic center.
METHODS: Thoracic reirradiation cases, discussed at the thoracic radiotherapy quality assurance (QA) meeting, were prospectively collected over 12 months between April 2024 and March 2025. Data collected included patient demographics, primary tumor site, details of previous and current planned radiotherapy, the extent and type of overlap and any treatment plan modifications. The data was analyzed using descriptive statistics.
RESULTS: 85 (18.2 % of 466 cases) reirradiation cases were identified at 26 QA meetings. Most reirradiation plans (68.2 %) were of radical intent, with dose overlap (89.4 %, n = 76). Challenges included unreliable registration of prior radiotherapy datasets (16.5 %) and deciding appropriate plan modifications to improve safety: 24.7 % optimized dose distribution to an OAR, 23.5 % involved dose reductions from standard prescriptions and 15.3 % compromised target volume coverage. The most frequently identified dose-limiting OARs were the proximal bronchial tree, esophagus, and spinal cord. Concerns about a lack of normal tissue recovery arose in 7.1 % of cases. In 10.6 % of cases there was explicit discussion of a dose discount for OARs for presumed partial tissue recovery. Peer-review prompted revision of the treatment plan in 11.8 % of cases.
CONCLUSION: These findings underscore the complexity of thoracic reirradiation and highlight the need for further guidance in the area and the role of QA rounds in optimizing safety and treatment decisions while best practice remains uncertain.
METHODS: Thoracic reirradiation cases, discussed at the thoracic radiotherapy quality assurance (QA) meeting, were prospectively collected over 12 months between April 2024 and March 2025. Data collected included patient demographics, primary tumor site, details of previous and current planned radiotherapy, the extent and type of overlap and any treatment plan modifications. The data was analyzed using descriptive statistics.
RESULTS: 85 (18.2 % of 466 cases) reirradiation cases were identified at 26 QA meetings. Most reirradiation plans (68.2 %) were of radical intent, with dose overlap (89.4 %, n = 76). Challenges included unreliable registration of prior radiotherapy datasets (16.5 %) and deciding appropriate plan modifications to improve safety: 24.7 % optimized dose distribution to an OAR, 23.5 % involved dose reductions from standard prescriptions and 15.3 % compromised target volume coverage. The most frequently identified dose-limiting OARs were the proximal bronchial tree, esophagus, and spinal cord. Concerns about a lack of normal tissue recovery arose in 7.1 % of cases. In 10.6 % of cases there was explicit discussion of a dose discount for OARs for presumed partial tissue recovery. Peer-review prompted revision of the treatment plan in 11.8 % of cases.
CONCLUSION: These findings underscore the complexity of thoracic reirradiation and highlight the need for further guidance in the area and the role of QA rounds in optimizing safety and treatment decisions while best practice remains uncertain.