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

作者：Victoria L Doss, Cecília Almeida e Sousa, Elaina Hales, Tinker Trent, Esi Hagan, Tsion Gebre, Anas A. Obaideen, M. Negassa, Dezhi Liu, Chen Hu, Akila N. Viswanathan, Heng Li, Khinh Ranh Voong, Xun Jia, Todd McNutt, Rachel B. Ger, Russell Kenneth Hales · 发表于：Radiotherapy and Oncology · 年份：2025 · DOI：10.1016/j.radonc.2025.111130 · 被引用次数：2 · 研究领域：Lung Cancer Diagnosis and Treatment、Effects of Radiation Exposure、Management of metastatic bone disease

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 ca...