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Create a Free AccountCurrent Challenges of Patient Re-irradiation
Gamma Knife radiosurgery: Scenarios and support for re-irradiation
While stereotactic radiosurgery (SRS) was originally conceived as a single-treatment technique [1], the case for re-irradiation in SRS has grown as a method to manage cases of disease progression after traditional large field treatments [2–4], and local failures [5–9], as well as incomplete response [10]. The high success rates of SRS have also led to attempts to treat larger tumors or tumors very close to sensitive normal tissue structures [11–15].Digital biomarkers: Importance of patient stratification for re-irradiation of glioma patients – Review of latest developments regarding scoring assessment
Scoring systems are used in many oncological areas and serve as prognosis or therapy decision. Recently, scores for prognostic assessment for diagnosis such as brain metastases (recursive partitioning analysis (RPA), graded prognostic assessment GPA) [1,2], prostate [3] or gliomas [4–9] were established. The calculation strategies are very different, ranging from simple calculations with point systems, to nomograms, to complex formulas determined by statistical models. Of course, all of these factors can be used independently, however, complex calculations using models and other tools (such as mobile or web-based apps) can help quickly to calculate nomograms or other “numbers”, which correlate well with outcome.Re-irradiation of vertebral bodies
Recurrence or second cancers regularly require a second (or third) radio-oncological treatment. Fortunately, the amount and quality of clinical data on the outcome and particularly the adverse events of re-irradiation constantly ameliorate [1,2]. Due to improvements in clinical care and therapy, more and more patients are being diagnosed with and living longer with vertebral metastases. Approximately 60–70% of patients with systemic cancer will develop vertebral metastases [3]. Vertebral tumours are important in clinical practice because their presence can significantly affect patient quality of life.Spinal cord re-treatments using photon and proton based radiotherapy: LQ-derived tolerance doses
The decision to recommend radiotherapy is never trivial, and is based on careful assessments of the potential benefits and associated risks. Re-treatment using photon-based Radiotherapy, although less commonly used, requires additional care in terms of patient selection, as either a radical or palliative approach to recurrent or metastatic tumour, or for new cancers occurring in an adjacent site. Parts of the central nervous system (CNS) are irradiated not only when treating tumours that originate in the CNS, but also when treating cancers that originate in other tissues.Second re-irradiation: A delicate balance between safety and efficacy
Radiation oncologists involved in palliative treatment scenarios frequently prescribe repeated courses of radiotherapy to anatomically distinct parts of the body, e.g., because of newly arising painful bone metastases. Due to non-overlapping dose distributions and moderate biologically equivalent doses, this type of retreatment is not particularly challenging. The complexity of decision-making and treatment planning increases when the new lesion is located close to the previous target volume, even in the absence of direct re-irradiation of an already treated lesion.
