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• W3139068082 abstract "Local recurrence or second lung primaries are common indications for radical thoracic re-irradiation (re-RT), affecting approximately 700 patients in the UK annually. Re-RT is usually the only suitable curative-intent treatment but prospective evidence on toxicity, dose constraints, and optimal treatment technique is lacking. We performed a Delphi process to identify areas of consensus in re-RT for NSCLC. An international panel of 15 radiation oncologists specialising in lung cancer participated in an initial survey on 23/09/2019 to capture their definition of re-RT, suitable patients, re-RT technique and dose constraints used. The most common responses to questions from the first survey were used to make statements which participants voted on in subsequent rounds using a 5-point Likert scale. Consensus was achieved once 75% of participants agreed with a statement. For the statements which did not reach consensus, respondents provided additional evidence/comments to refine them. In total, four surveys were performed using a web-based survey programme. All respondents completed three rounds of the survey, with the final round currently in progress. Consensus was achieved within two rounds regarding re-RT indications, patient eligibility and work-up (Table 1). In addition, agreement was reached to use stereotactic ablative body radiotherapy (SABR) if possible for re-RT. Dose constraints, due to the lack of supportive data, required three rounds to develop agreement. Several volumetric lung constraints were suggested, but due to post-radiotherapy fibrosis, it was concluded that there was insufficient evidence to form recommendations (Table 2). Areas of controversy were how much overlap was significant when performing re-RT, what were the minimum lung function requirements and the minimum safe interval between treatments.Tabled 1StatementDegree of ConsensusIndicationsRe-RT can be considered for suspected new lung primaries with minimal overlap with previous radiotherapy fields.93%Re-RT can be considered for lung tumours which develop new nodal disease after an initial course of radiotherapy only to the primary tumour (therefore minimal overlap).100%Re-RT can be considered where a lung tumour relapses locally (or develops a suspected second primary tumour with >50% overlap with the original primary tumour), but low overlap with serial structures in the thorax.93%Patient eligibilityIn general, patients should have an ECOG PS of 0 - 2 to be considered for re-RT, with exceptions being made for selected PS 3 patients (e.g. SABR re-RT, or PS 3 due to non-respiratory issues).93%Re-irradiation should be avoided in patients with interstitial lung disease.86%Surgery should be considered in all appropriate patients being assessed for re-irradiation.93%Work-upEssential investigations prior to commencing re-RT are: Whole body PET-CT, CT chest + contrast, and CT/MRI brain.93-100% Open table in a new tab Tabled 1StatementDegree of consensusDose constraintsFor radical re-irradiation, the desirable cumulative maximum point dose constraint to the oesophagus is an EQD2 of 75Gy, although up to 100Gy is acceptable (using an a/b=3), with the volume of the oesophagus getting 55 Gray should be less than 35% (V55Gy<35%).86%For radical re-irradiation, the desirable cumulative maximum point dose constraint to the spinal cord is an EQD2 of 60Gy (using a/b=2), provided that the initial irradiation dose to the cord did not exceed 50Gy and the interval between treatments is greater than 6 months.80%For radical re-irradiation, the desirable cumulative maximum dose (Dmax) constraint to the aorta is an EQD2 of 115Gy (a/b=3). The desirable cumulative Dmax to the pulmonary artery is an EQD2 of 110Gy.80%There is insufficient evidence to suggest volumetric cumulative dose constraints for the lung due to the changes in anatomy and function of the lung after an initial course of radiotherapy.80%TechniqueRadical re-irradiation should be performed using highly conformal radiotherapy techniques (e.g. VMAT, Tomotherapy, Cyberknife).100%Acceptable doses for conventionally fractionated re-RT include 60Gy in 30 fractions or 55Gy in 20 fractions once daily for NSCLC93%SABR is the preferred re-RT technique where the tumour is not ultra-central, no nodal disease and the tumour volume is small with minimal overlap with OARs.87%Any dose and fractionation that can safely deliver a BED >100Gy to the tumour is acceptable for radical re-irradiation with SABR.87% Open table in a new tab This Delphi process with international experts has developed key recommendations on the criteria for suitable re-RT patients, dose constraints and preferred technique. These statements can be used to develop prospective trials to provide better evidence for re-RT." @default.
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• W3139068082 title "P05.02 International Delphi Consensus on Radical Thoracic Re-Irradiation for Non-Small Cell Lung Cancer (NSCLC)" @default.
• W3139068082 doi "https://doi.org/10.1016/j.jtho.2021.01.393" @default.
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