Beddok Arnaud, Willmann Jonas, Embring Anna, Appelt Ane L, Balermpas Panagiotis, Chua Kevin, Choi J Isabelle, Elger Bernice Simone, Gabrys Dorota, Hoskin Peter, Niyazi Maximilian, Pasquier David, Paradis Kelly, Kaidar-Person Orit, Plaisier Corien, Schmitt Nicole C, Steuer Conor E, Thariat Juliette, Yom Sue S, Poortmans Philip, Vasquez Osorio Eliana, Andratschke Nicolaus
Department of Radiation Oncology, Institut Godinot, Reims, France.
Research Center in Information and Communication Sciences and Technologies, University of Champagne-Ardenne, Reims, France.
CA Cancer J Clin. 2025 May 29. doi: 10.3322/caac.70016.
Reirradiation (reRT), defined as administering a course of radiation therapy to a specific area previously irradiated, is an evolving treatment strategy for locoregionally recurrent cancer that offers significant potential and poses inherent challenges. Advances in such techniques as intensity-modulated and stereotactic body radiation therapy have improved precision, making reRT a viable option for complex scenarios previously deemed high-risk. Nevertheless, reRT remains associated with substantial risks-including life-threatening side effects, functional impairments, and psychosocial effects-which must be carefully balanced against the patient's overall health and the likelihood of achieving cancer control or palliation. Patient selection is essential to optimize outcomes while mitigating risks. Decisions should account for tumor characteristics at the time of primary diagnosis and recurrence, elapsed time since prior treatment, the possibility of delivering meaningful doses to the tumor, and the cumulative irradiation tolerance of normal tissues. Advanced imaging modalities, such as functional magnetic resonance imaging and fluorine-18-labeled fluorodeoxyglucose-positron emission tomography, are important for distinguishing recurrences from treatment-induced changes, refining treatment targets, and minimizing exposure to healthy tissue. Combined treatment with systemic regimens-targeted therapies and immunotherapy in particular-offers promising opportunities but requires coordination to manage side effects. Standardized guidelines, such as those from the European Society of Therapeutic Radiology and Oncology-European Society for Research and Treatment of Cancer, are essential for improving the consistency of reporting, guiding clinical decision making, and fostering patient-centered care. Multidisciplinary collaboration and ongoing research, particularly through clinical trials, are central to fully exploiting reRT strategies. In addition, the development of innovative techniques, such as proton therapy, would likely enable safer treatments. These efforts aim to improve the therapeutic balance of reRT, enhancing outcomes and quality of life.
再程放疗（reRT）被定义为对先前接受过放疗的特定区域进行一个疗程的放射治疗，它是一种不断发展的针对局部区域复发性癌症的治疗策略，具有巨大潜力，但也带来了内在挑战。调强放疗和立体定向体部放疗等技术的进步提高了精确性，使再程放疗成为先前被视为高风险的复杂情况的可行选择。然而，再程放疗仍然伴随着重大风险，包括危及生命的副作用、功能障碍和心理社会影响，必须在患者的整体健康状况与实现癌症控制或姑息治疗的可能性之间仔细权衡。患者选择对于优化治疗结果同时降低风险至关重要。决策应考虑初次诊断和复发时的肿瘤特征、上次治疗后的时间间隔、向肿瘤输送有效剂量的可能性以及正常组织的累积照射耐受性。功能磁共振成像和氟 - 18标记的氟脱氧葡萄糖 - 正电子发射断层扫描等先进成像方式对于区分复发与治疗引起的变化、完善治疗靶点以及减少对健康组织的照射至关重要。与全身治疗方案联合，特别是靶向治疗和免疫治疗，提供了有前景的机会，但需要协调以管理副作用。标准化指南，如欧洲治疗放射学和肿瘤学学会 - 欧洲癌症研究与治疗组织发布的指南，对于提高报告的一致性、指导临床决策以及促进以患者为中心的护理至关重要。多学科协作和持续研究，特别是通过临床试验，对于充分利用再程放疗策略至关重要。此外，质子治疗等创新技术的发展可能会实现更安全的治疗。这些努力旨在改善再程放疗的治疗平衡，提高治疗效果和生活质量。
