An international expert survey on the indications and practice of radical thoracic reirradiation for non-small cell lung cancer

Rulach, R. et al. (2021) An international expert survey on the indications and practice of radical thoracic reirradiation for non-small cell lung cancer. Advances in Radiation Oncology, 6(2), 100653. (doi: 10.1016/j.adro.2021.100653) (PMID:33851065) (PMCID:PMC8022147)

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Purpose: Thoracic re-irradiation for non-small cell lung cancer (NSCLC) with curative intent is potentially associated with severe toxicity. There are limited prospective data on the best method to deliver this treatment. We sought to develop expert consensus guidance on the safe practice of treating NSCLC with radiotherapy in the setting of prior thoracic irradiation. Methods and materials: Twenty-one thoracic radiation oncologists were invited to participate in an international Delphi consensus process. Guideline statements were developed and refined over four rounds on the definition of re-irradiation, appropriate patients and pre-treatment assessments, planning of radiotherapy, and cumulative dose constraints. Consensus was achieved once ≥75% of respondents agreed with a statement. Statements that did not reach consensus in the initial survey rounds were revised based on respondents’ comments and re-presented in subsequent rounds. Results: Fifteen radiation oncologists participated in the four surveys between September 2019 and March 2020. The first three rounds had a 100% response rate, and the final round was completed by 93% of participants. 33 out of 77 statements across all rounds achieved consensus. Key recommendations are: (1) appropriate patients should have a good performance status, can have locally relapsed disease or second primary cancers, and there are no absolute lung function values that preclude re-irradiation; (2) a full diagnostic work-up should be performed in patients with suspected local recurrence and; (3) any re-irradiation should be delivered using optimal image-guidance and highly conformal techniques. In addition, consensus cumulative dose for the organs at risk in the thorax are described. Conclusion: These consensus statements provide practical guidance on appropriate patient selection for re-irradiation, appropriate radiotherapy techniques, and cumulative dose constraints.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Rulach, Dr Robert and HARROW, Dr STEPHEN and Chalmers, Professor Anthony
Authors: Rulach, R., Ball, D., Chua, K., Dahele, M., De Ruysscher, D., Franks, K., Gomez, D., Guckenberger, M., Hanna, G., Louie, A., Moghanaki, D., Palma, D., Peedell, C., Salem, A., Silva, S., Videtic, G., Chalmers, A., and Harrow, S.
College/School:College of Medical Veterinary and Life Sciences > School of Cancer Sciences
Journal Name:Advances in Radiation Oncology
ISSN (Online):2452-1094
Published Online:20 January 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in Advances in Radiation Oncology 6(2): 100653
Publisher Policy:Reproduced under a Creative Commons licence

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
311790Assessing the efficacy and safety of a new radiotherapy planning method in lung re-irradiationAnthony ChalmersBeatson Cancer Charity (BEATCANC)17-18-043CS - Clinical Trials Research