European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus on re-irradiation: definition, reporting, and clinical decision making

Andratschke, Nicolaus; Willmann, Jonas; Appelt, Ane L; Alyamani, Najlaa; Balermpas, Panagiotis; Baumert, Brigitta G.; Hurkmans, Coen; Høyer, Morten; Langendijk, Johannes A.; Kaidar‐Person, Orit; Linden, Y. van der; Meattini, Icro; Niyazi, Maximilian; Reynaert, N.; Ruysscher, Dirk De; Tanadini‐Lang, Stephanie; Hoskin, Peter; Poortmans, Philip; Nieder, Carsten

doi:10.1016/s1470-2045(22)00447-8

Cited by 48 publications

(51 citation statements)

References 34 publications

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“…[3][4][5] For the fictitious RI scenario in this study, the three re-planning strategies performed equally well (Table 2, Figure 2, Figure 3a,b), which was expected due to the large distances between PTV and relevant OARs associated with RI treatments. 1 However, note the slightly elongated EQD2 distribution for reRT reduce compared to F I G U R E 3 Dose-volume histograms (DVHs) using dose and total equivalent dose in 2-Gy fraction (EQD2 tot ) for the three relapse scenarios-repeat irradiation (RI), re-irradiation type 1 (RIT1) and type 2 (RIT2). (a): DVHs for the planning target volumes (PTV) with a broken x-axis for reRT regular (black lines), reRT reduce (red lines) and reRT voxelwise (blue lines) for all three relapse scenarios with the PTV coverage goals marked as horizontal black triangles.…”

Section: Discussionmentioning

confidence: 99%

“…The use of EQD2 allows for dose summation of radiotherapy courses with different fractionation schedules and is often used for dose summations in re-irradiation treatments. 1,[3][4][5]10…”

Section: Re-irradiation Optimization Functionsmentioning

confidence: 99%

“…Subsequently, a fictitious spherical relapse gross tumor volume (GTV) of about 38 cm 3 (radius of 2.1 cm) was positioned in three distinct locations with identical coordinates in the superior-inferior direction to schematically represent 'repeat irradiation' (RI), 're-irradiation type 2′ (RIT2), and 're-irradiation type 1′ (RIT1) scenarios as defined by a recent European consensus report on re-irradiation. 1 The volume of the GTV corresponds to the median pelvic re-irradiation GTV from a systematic review on hypofractionated pelvic re-irradiation, 15 and the selected locations were inspired by the patterns of pelvic relapses 16 but had no anatomical meaning. In line with the recent increased interest in hypofractionated and ablative re-irradiation treatments, 15,17,18 three dual-arc VMAT plans of 35 Gy in 5 fractions (EQD2 = 70 Gy with α/β = 3 Gy) were optimized for each relapse PTV (3 mm isotropic expansion of the corresponding GTV) using the full 3D dose distribution from the first treatment course as the estimated previously delivered dose (i.e., EQD2 deliv in Equation ( 2)).…”

Section: Re-irradiation Treatment Planningmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Radiotherapy treatment to a previously irradiated volume, so‐called re‐irradiation, is a promising technique, used in an increasing number of patients in a large variety of treatment sites 1 . Although few definitive guidelines exist and high‐quality re‐irradiation prospective data are lacking, 1–3 several of the well‐recognized challenges associated with re‐irradiation have been studied. These include the need to retrieve accurate image and dose data, handling of anatomical changes between the radiotherapy courses, integration of radiobiology when summing multiple radiotherapy courses, and deciding on clinically relevant dose constraints 3–8 .…”

Section: Introductionmentioning

confidence: 99%

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Technical note: Optimization functions for re‐irradiation treatment planning

Ödén,

Eriksson,

Svensson

et al. 2023

Medical Physics

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BackgroundAlthough re‐irradiation is increasingly used in clinical practice, almost no dedicated planning software exists.PurposeStandard dose‐based optimization functions were adjusted for re‐irradiation planning using accumulated equivalent dose in 2‐Gy fractions (EQD2) with rigid or deformable dose mapping, tissue‐specific α/β, treatment‐specific recovery coefficients, and voxelwise adjusted EQD2 penalization levels based on the estimated previously delivered EQD2 (EQD2deliv).MethodsTo demonstrate proof‐of‐concept, 35 Gy in 5 fractions was planned to a fictitious spherical relapse planning target volume (PTV) in three separate locations following previous prostate treatment on a virtual human phantom. The PTV locations represented one repeated irradiation scenario and two re‐irradiation scenarios. For each scenario, three re‐planning strategies with identical PTV dose‐functions but various organ at risk (OAR) EQD2‐functions was used: reRTregular: Regular functions with fixed EQD2 penalization levels larger than EQD2deliv for all OAR voxels. reRTreduce: As reRTregular, but with lower fixed EQD2 penalization levels aiming to reduce OAR EQD2. reRTvoxelwise: As reRTregular and reRTreduce, but with voxelwise adjusted EQD2 penalization levels based on EQD2deliv. PTV near‐minimum and near‐maximum dose (D98%/D2%), homogeneity index (HI), conformity index (CI) and accumulated OAR EQD2 (α/β = 3 Gy) were evaluated.ResultsFor the repeated irradiation scenario, all strategies resulted in similar dose distributions. For the re‐irradiation scenarios, reRTreduce and reRTvoxelwise reduced accumulated average and near‐maximum EQD2 by ˜1–10 Gy for all relevant OARs compared to reRTregular. The reduced OAR doses for reRTreduce came at the cost of distorted dose distributions with D98% = 92.3%, HI = 12.0%, CI = 73.7% and normal tissue hot spots ≥150% for the most complex scenario, while reRTregular (D98% = 98.1%, HI = 3.2%, CI = 94.2%) and reRTvoxelwise (D98% = 96.9%, HI = 6.1%, CI = 93.7%) fulfilled PTV coverage without hot spots.ConclusionsThe proposed re‐irradiation‐specific EQD2‐based optimization functions introduce novel planning possibilities with flexible options to guide the trade‐off between target coverage and OAR sparing with voxelwise adapted penalization levels based on EQD2deliv.

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Section: Discussionmentioning

confidence: 99%

“…The use of EQD2 allows for dose summation of radiotherapy courses with different fractionation schedules and is often used for dose summations in re-irradiation treatments. 1,[3][4][5]10…”

Section: Re-irradiation Optimization Functionsmentioning

confidence: 99%

Section: Re-irradiation Treatment Planningmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Technical note: Optimization functions for re‐irradiation treatment planning

Ödén,

Eriksson,

Svensson

et al. 2023

Medical Physics

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Partial Breast Irradiation

Meattini,

Keleti,

Poortmans

2024

Hypofractionated and Stereotactic Radiation Therapy

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Radiation Oncology in the UAE

Abu-Gheida,

Mahmood,

Geara

et al. 2024

Cancer Care in the United Arab Emirates

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Radiation oncology is an essential component of cancer treatment. The field of radiotherapy in the United Arab Emirates (UAE) has been well established and is currently growing steadily in the UAE. This chapter focuses on all the different aspects of the radiotherapy field and department(s) in the UAE. Tackling the origin and history of radiation. Moreover, with the history and present of different radiotherapy departments in the UAE, along with the definition and roles of different radiotherapy team members. Furthermore, the roles of different key players in the radiotherapy community in the UAE, including regulatory bodies, suppliers, and societies, are discussed here. Finally, radiotherapy-related education and training in the UAE, research, and potential future directions to continue moving the field forward in the UAE and the region are also summarized.

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European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus on re-irradiation: definition, reporting, and clinical decision making

Cited by 48 publications

References 34 publications

Technical note: Optimization functions for re‐irradiation treatment planning

Technical note: Optimization functions for re‐irradiation treatment planning

Partial Breast Irradiation

Radiation Oncology in the UAE

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