Andratschke Nicolaus, Willmann Jonas, Appelt Ane L, Day Madalyne, Kronborg Camilla, Massaccesi Mariangela, Ozsahin Mahmut, Pasquier David, Petric Primoz, Riesterer Oliver, De Ruysscher Dirk, M Van der Velden Joanne, Guckenberger Matthias
Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Switzerland.
Leeds Institute of Medical Research at St James's, University of Leeds, UK.
Clin Transl Radiat Oncol. 2024 Oct 2;49:100871. doi: 10.1016/j.ctro.2024.100871. eCollection 2024 Nov.
With the emergence of high-precision radiotherapy technologies such as stereotactic ablative radiotherapy (SABR), MR guided brachytherapy, image guided intensity modulated photon and proton radiotherapy and most recently daily adaptive radiotherapy, reirradiation is increasingly recognized as a viable treatment option for many patients. This includes those with recurrent, metastatic or new malignancies post initial radiotherapy. The primary challenge in reirradiation lies in balancing tumor control against the risk of severe toxicity from cumulative radiation doses to previously irradiated normal tissue. Although technology for precise delivery has advanced at a fast pace, clinical practice of reirradiation still mostly relies on individual expertise, as prospective evidence is scarce, the level of reporting in clinical studies is not standardized and of low quality - especially with respect to cumulative doses received by organs at risk. A recent ESTRO/EORTC initiative proposed a standardized definition of reirradiation and formulated general requirements for minimal reporting in clinical studies [1]. As a consequence we found it timely to convene for an international and interdisciplinary meeting with experts in the field to summarize the current evidence, identify knowledge gaps and explore which best practices can be derived for safe reirradiation. The meeting was held on 15.06.2023 in Zurich and was endorsed by the scientific societies SASRO, DEGRO and ESTRO. Here, we report on available evidence and research priorities in the field of reirradiation, as discussed during the meeting.
随着立体定向消融放疗（SABR）、磁共振引导近距离放疗、图像引导调强光子和质子放疗以及最近的每日自适应放疗等高精放疗技术的出现，再程放疗越来越被认为是许多患者可行的治疗选择。这包括那些在初次放疗后出现复发、转移或新发恶性肿瘤的患者。再程放疗的主要挑战在于平衡肿瘤控制与既往照射过的正常组织因累积辐射剂量而产生严重毒性的风险。尽管精确放疗技术发展迅速，但再程放疗的临床实践仍大多依赖个人经验，因为前瞻性证据稀缺，临床研究的报告水平不规范且质量较低——尤其是关于危及器官所接受的累积剂量方面。欧洲放射肿瘤学会（ESTRO）/欧洲癌症研究与治疗组织（EORTC）最近发起了一项倡议，提出了再程放疗的标准化定义，并制定了临床研究最低报告要求[1]。因此，我们认为及时召开一次该领域专家的国际跨学科会议，以总结当前证据、识别知识空白并探索可用于安全再程放疗的最佳实践是很有必要的。会议于2023年6月15日在苏黎世举行，并得到了科学协会SASRO、DEGRO和ESTRO的认可。在此，我们报告会议期间讨论的再程放疗领域的现有证据和研究重点。
