Rulach Robert, Ball David, Chua Kevin L M, Dahele Max, De Ruysscher Dirk, Franks Kevin, Gomez Daniel, Guckenberger Matthias, Hanna Gerard G, Louie Alexander V, Moghanaki Drew, Palma David A, Peedell Clive, Salem Ahmed, Siva Shankar, Videtic Gregory M M, Chalmers Anthony J, Harrow Stephen
Institute of Cancer Sciences, The University of Glasgow, Glasgow, UK.
Department of Clinical Oncology, The Beatson West of Scotland Cancer Centre, Glasgow, UK.
Adv Radiat Oncol. 2021 Jan 20;6(2):100653. doi: 10.1016/j.adro.2021.100653. eCollection 2021 Mar-Apr.
Thoracic reirradiation for non-small cell lung cancer 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 non-small cell lung cancer with radiation therapy in the setting of prior thoracic irradiation.
Twenty-one thoracic radiation oncologists were invited to participate in an international Delphi consensus process. Guideline statements were developed and refined during 4 rounds on the definition of reirradiation, selection of appropriate patients, pretreatment assessments, planning of radiation therapy, 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.
Fifteen radiation oncologists participated in the 4 surveys between September 2019 and March 2020. The first 3 rounds had a 100% response rate, and the final round was completed by 93% of participants. Thirty-three out of 77 statements across all rounds achieved consensus. Key recommendations are as follows: (1) appropriate patients should have a good performance status and can have locally relapsed disease or second primary cancers, and there are no absolute lung function values that preclude reirradiation; (2) a full diagnostic workup should be performed in patients with suspected local recurrence and; (3) any reirradiation 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.
These consensus statements provide practical guidance on appropriate patient selection for reirradiation, appropriate radiation therapy techniques, and cumulative dose constraints.
对非小细胞肺癌进行具有治愈意图的胸部再程放疗可能会带来严重毒性。关于实施这种治疗的最佳方法，前瞻性数据有限。我们试图就先前接受过胸部放疗的情况下，用放射治疗治疗非小细胞肺癌的安全实践制定专家共识指南。
邀请了21名胸部放射肿瘤学家参与国际德尔菲共识过程。在四轮过程中制定并完善了关于再程放疗的定义、合适患者的选择、治疗前评估、放射治疗计划和累积剂量限制的指南声明。一旦≥75%的受访者同意某一声明，即达成共识。在初始调查轮次中未达成共识的声明根据受访者的意见进行修订，并在后续轮次中重新呈现。
15名放射肿瘤学家参与了2019年9月至2020年3月期间的4次调查。前三轮的回复率为100%，最后一轮由93%的参与者完成。所有轮次中的77条声明中有33条达成了共识。主要建议如下：（1）合适的患者应具有良好的身体状况，可能患有局部复发性疾病或第二原发性癌症，并且没有绝对的肺功能值会排除再程放疗；（2）对疑似局部复发的患者应进行全面的诊断检查；（3）任何再程放疗都应使用最佳图像引导和高度适形技术进行。此外，还描述了胸部危险器官的共识累积剂量。
这些共识声明为再程放疗的合适患者选择、合适的放射治疗技术和累积剂量限制提供了实用指导。
