Kaplan Laura P, Tobin Rebecca J, Appelt Ane, Vasquez Osorio Eliana, Wahlstedt Isak, Christiansen Rasmus L, Nielsen Martin S, Rechner Laura A, Thomsen Simon N, Lund Mikkel D, Jensen Kenneth, Kronborg Camilla, Hoffmann Lone
Department of Oncology and Palliative Units, Zealand University Hospital, Næstved, Denmark.
Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Acta Oncol. 2025 Jul 24;64:946-956. doi: 10.2340/1651-226X.2025.43567.
Reirradiation is becoming more frequent in clinical practice. However, workflows and practices vary widely between clinics, as general guidelines are scarce or lacking in practical detail. This paper presents comprehensive national Danish consensus recommendations covering all steps of the reirradiation workflow. The aim is to standardise and improve reirradiation treatment quality and provide guidance for much-needed large-scale clinical trials.
An expert panel was formed comprising physicians, clinical physicists, and clinical researchers from all Danish radiotherapy centres. An in-person 2-day workshop was followed by multiple online meetings. Recommendations were based on expert consensus, supported by review of existing literature, and were reviewed by all Danish Multidisciplinary Cancer Groups before publication.
Reirradiation cases should be designated clearly as such at each workflow step. Review of patient cases at multidisciplinary reirradiation conferences is encouraged. Immobilisation, positioning, and motion management should resemble that of previous treatment(s) as closely as possible. Information on previous dose should be used in planning and evaluation. The degree of complexity (e.g. summation of dose maxima, rigid/deformable image registration, 3D dose accumulation) should reflect the clinical situation as well as the extent/quality of available information. Dose should always be converted to an equieffective dose before summation. Daily image-guidance and regular evaluation of delivered dose are recommended. We provide guidance on quality assurance of dose mapping and guidelines for clinical reirradiation trials.
We present national consensus guidelines for site-independent reirradiation treatment workflows. The guidelines have been approved by the site-specific Danish Multidisciplinary Cancer Groups.
再程放疗在临床实践中越来越常见。然而，各诊所的工作流程和做法差异很大，因为通用指南稀缺或缺乏实际细节。本文提出了涵盖再程放疗工作流程所有步骤的丹麦全国性综合共识建议。目的是规范和提高再程放疗的治疗质量，并为急需的大规模临床试验提供指导。
成立了一个专家小组，成员包括丹麦所有放疗中心的医生、临床物理师和临床研究人员。先举行为期2天的面对面研讨会，随后召开多次线上会议。建议基于专家共识，并得到对现有文献的综述支持，在发表前由所有丹麦多学科癌症小组进行了审查。
在每个工作流程步骤中，再程放疗病例都应明确标识。鼓励在多学科再程放疗会议上对患者病例进行审查。固定、定位和运动管理应尽可能与先前治疗相似。先前剂量的信息应在计划和评估中使用。复杂程度（例如剂量最大值总和、刚性/可变形图像配准、三维剂量累积）应反映临床情况以及可用信息的范围/质量。在求和之前，剂量应始终转换为等效剂量。建议进行每日图像引导和对已交付剂量的定期评估。我们提供了剂量映射质量保证指南以及临床再程放疗试验指南。
我们提出了针对与部位无关的再程放疗治疗工作流程的全国性共识指南。这些指南已得到丹麦特定部位多学科癌症小组的批准。
