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International Delphi consensus on radical thoracic re-irradiation for non-small cell lung cancer (NSCLC)
Rulach, R. Guckenberger, M. De Ruysscher, D Palma, D. Louie, A. Ball, D. Hanna, G. Siva, S. Salem, Ahmed Videtic, G.
Rulach, R.
Guckenberger, M.
De Ruysscher, D
Palma, D.
Louie, A.
Ball, D.
Hanna, G.
Siva, S.
Salem, Ahmed
Videtic, G.
Citations
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Abstract
Introduction: 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.
Methods: 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. Results: 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, agreementwas
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. Conclusion:
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.
Description
Date
2021
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Rulach R, Guckenberger M, De Ruysscher D, Palma D, Louie A, Ball D, et al. P05.02 International Delphi Consensus on Radical Thoracic Re-Irradiation for Non-Small Cell Lung Cancer (NSCLC). Journal of Thoracic Oncology. 2021 Mar;16(3):S266–7.