Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore; Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, China.
Mount Vernon Cancer Centre and Division of Cancer Sciences, University of Manchester, Manchester, UK.
Ann Palliat Med. 2024 Jul;13(4):1150-1153. doi: 10.21037/apm-24-4. Epub 2024 May 28.
Indications for re-irradiation are increasing both for palliation and potentially curative attempts to achieve durable local control. This has been in part driven by the technological advances in the last decade including image-guided brachytherapy, volumetric-modulated arc therapy and stereotactic body radiotherapy. These enable high dose focal irradiation to be delivered to a limited target volume with minimal normal tissue re-irradiation. The European Society for Radiotherapy and Oncology (ESTRO) and the European Organisation for Research and Treatment of Cancer (EORTC) have collaboratively developed a comprehensive consensus on re-irradiation practices, aiming to standardise definitions, reporting, and clinical decision-making processes. The document introduces a universally applicable definition for re-irradiation, categorised into two primary types based on the presence of geometric overlap of irradiated volumes and concerns for cumulative dose toxicity. It also identifies "repeat organ irradiation" and "repeat irradiation" for cases without such overlap, emphasising the need to consider toxicity risks associated with cumulative doses. Additionally, the document presents detailed reporting guidelines for re-irradiation studies, specifying essential patient and tumour characteristics, treatment planning and delivery details, and follow-up protocols. These guidelines are designed to improve the quality and reproducibility of clinical research, thus fostering a more robust evidence base for future re-irradiation practices. The consensus underscores the necessity of interdisciplinary collaboration and shared decision-making, highlighting performance status, patient survival estimates, and response to initial radiotherapy as critical factors in determining eligibility for re-irradiation. It advocates for a patient-centric approach, with transparent communication about treatment intent and potential risks. Radiobiological considerations, including the application of the linear-quadratic model, are recommended for assessing cumulative doses and guiding re-irradiation strategies. By providing these comprehensive recommendations, the ESTRO-EORTC consensus aims to enhance the safety, efficacy, and quality of life for patients undergoing re-irradiation, while paving the way for future research and refinement of treatment protocols in the field of oncology.
再放疗的适应证正在增加，无论是姑息性治疗还是潜在的根治性尝试，以实现持久的局部控制。这在一定程度上是由于过去十年中的技术进步推动的，包括图像引导近距离放疗、容积调强弧形治疗和立体定向体部放疗。这些技术使高剂量焦点照射能够在最小的正常组织再照射的情况下传递到有限的靶体积。欧洲放射治疗和肿瘤学学会（ESTRO）和欧洲癌症研究与治疗组织（EORTC）合作制定了一份关于再放疗实践的综合共识，旨在使定义、报告和临床决策过程标准化。该文件引入了一种普遍适用的再放疗定义，根据照射体积的几何重叠和累积剂量毒性的关注，将其分为两种主要类型。它还为没有这种重叠的病例确定了“重复器官照射”和“重复照射”，强调需要考虑与累积剂量相关的毒性风险。此外，该文件还提出了再放疗研究的详细报告指南，规定了基本的患者和肿瘤特征、治疗计划和交付细节以及随访方案。这些指南旨在提高临床研究的质量和可重复性，从而为未来的再放疗实践提供更强大的证据基础。共识强调了跨学科合作和共同决策的必要性，突出了表现状态、患者生存估计和对初始放疗的反应是确定再放疗资格的关键因素。它提倡以患者为中心的方法，就治疗意图和潜在风险进行透明沟通。推荐使用放射生物学考虑因素，包括线性二次模型的应用，来评估累积剂量并指导再放疗策略。通过提供这些全面的建议，ESTRO-EORTC 共识旨在提高接受再放疗患者的安全性、疗效和生活质量，同时为该领域的未来研究和治疗方案的改进铺平道路。
