Efficacy and safety of twice-daily accelerated hyperfractionated re-irradiation for thoracic malignancies

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2025-09-10 DOI:10.1016/j.radonc.2025.111130

Victoria L. Doss , Cecilia F.P.M. de Sousa , Elaina Hales , Tinker Trent , Esi Hagan , Tsion Gebre , Anas Obaideen , Meti Negassa , Dezhi Liu , Chen Hu , Akila N. Viswanathan , Heng Li , K.Ranh Voong , Xun Jia , Todd McNutt , Rachel B. Ger , Russell K. Hales

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引用次数: 0

Abstract

Introduction

Balancing the demands for dose-escalated re-irradiation with toxicity to organs at risk (OARs) is a challenge. Twice-daily (BID) accelerated hyperfractionated re-irradiation (re-RT) is a potential solution, yet there is no guidance for its application for thoracic malignancies.

Methods

All BID thoracic re-RT cases at our institution since 2014 were reviewed. Prior radiation courses were deformably registered. Summary plan dosimetrics were extracted using per-voxel cumulative EQD2 (α/β = 3 for normal tissues). Maximum toxicity following BID re-RT was graded per CTCAE v5.0 and assessed for relationship to radiation. Local failure (LF), progression-free survival (PFS), and overall survival (OS) were measured and compared between subgroups based on histology, re-RT dose, and metastatic status.

Results

Sixty-four BID re-RT cases delivering at least 45 Gy in 30 fractions were reviewed. Fifty-eight patients (90.6 %) received a prior definitive course of radiation. The median first course EQD2 (α/β = 10) was 60.2 Gy. Median follow-up after re-RT was 14.2 months. Median OS was 18.5 months from completion of BID re-RT, and 59.0 % of patients had sustained local control at two years. Ten patients (15.6 %) experienced grade ≥3 toxicity. There were no grade 4 toxicities. There was one grade 5 event possibly attributable to re-RT. Of 24 OAR doses exceeding American Radium Society (ARS) and American College of Radiology (ACR) cumulative dose recommendations for re-RT, one case was associated with grade ≥3 toxicity.

Conclusions

Accelerated hyperfractionated BID re-RT is safe and effective for thoracic re-RT, providing durable local control and favorable survival outcomes with acceptable toxicity.

查看原文本刊更多论文

每日两次加速高分割再照射治疗胸部恶性肿瘤的疗效和安全性。

在剂量递增的再照射需求和对危险器官（OARs）的毒性之间取得平衡是一个挑战。每日两次（BID）加速超分割再照射（re-RT）是一种潜在的解决方案，但对于其在胸部恶性肿瘤中的应用尚无指导。方法：回顾性分析我院2014年以来所有BID胸腔re-RT病例。先前的放射疗程记录变形。使用每体素累积EQD2（正常组织α/β = 3）提取总结计划剂量。根据CTCAE v5.0分级BID - re-RT后的最大毒性，并评估其与辐射的关系。测量局部失败（LF）、无进展生存期（PFS）和总生存期（OS），并根据组织学、re-RT剂量和转移状态在亚组之间进行比较。结果：回顾了64例BID再rt病例，30个分数至少45 Gy。58例患者（90.6 %）接受了明确的放射治疗。首个疗程中位EQD2 （α/β = 10）为60.2 Gy。再放射治疗后的中位随访时间为14.2 个月。BID - re-RT完成后的中位OS为18.5 个月，59.0% %的患者在两年内保持局部控制。10例患者（15.6 %）出现≥3级毒性。没有4级毒性。有1例5级事件可能归因于re-RT。在24例OAR剂量超过美国镭学会（ARS）和美国放射学会（ACR）推荐的re-RT累积剂量中，有1例毒性≥3级。结论：加速超分割BID再rt对于胸部再rt是安全有效的，提供持久的局部控制和良好的生存结果，毒性可接受。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.