Table 1.
Consensus statements regarding suitable patients and pretreatment assessment
| Consensus agreed | SA/A, % | N, % | D/SD, % | Round agreed | Median | |
|---|---|---|---|---|---|---|
| 1.1 | Radical reirradiation can be considered for suspected new lung primaries with minimal overlap with previous radiation therapy fields. | 93 | 7 | 0 | R2 | SA |
| 1.2 | Radical reirradiation can be considered for lung tumors that develop new nodal disease after an initial course of radiation therapy only to the primary tumor (therefore minimal overlap). | 100 | 0 | 0 | R2 | SA |
| 1.3 | Radical reirradiation can be considered where a lung tumor relapses locally (or develops a suspected second primary tumor with >50% overlap with the original primary tumor), but low overlap with serial structures in the thorax. | 93 | 0 | 7 | R2 | SA |
| 1.4 | Alternative treatments (e.g., systemic therapy) are preferred to radical reirradiation to the primary lung cancer where the lung tumors have relapsed both locally and with widespread metastatic disease. | 93 | 7 | 0 | R2 | A |
| 1.5 | In general, patients should have an ECOG PS of 0-2 to be considered for radical dose reirradiation, with exceptions being made for selected PS 3 patients (e.g., SABR reirradiation, or PS 3 due to nonrespiratory issues). | 93 | 0 | 7 | R2 | SA |
| 1.6 | Reirradiation should be avoided in patients with interstitial lung disease. | 86 | 7 | 7 | R2 | SA |
| 1.7 | Reirradiation should be performed cautiously with patients who developed grade 3 or higher toxicity with their initial radiation treatment. | 86 | 7 | 7 | R2 | A |
| 1.8 | Surgery should be considered in all appropriate patients being assessed for reirradiation. | 93 | 0 | 7 | R2 | A |
| 1.9 | In locally advanced recurrent lung cancer, where there is an increased likelihood of response to immunotherapy (e.g., PD-L1 >50%), immunotherapy may be preferable to high-risk radical reirradiation. | 80 | 0 | 20 | R2 | A |
| 1.10 | In locally advanced recurrent lung cancer, where there is an actionable mutation (e.g., EGFR mutation, ALK fusion), targeted treatment may be preferable to high-risk radical reirradiation. | 79 | 7 | 14 | R2 | A |
| 1.11 | Investigations before commencing radical reirradiation are whole body PET-CT, CT chest + contrast, and CT/MRI brain. | >93 | - | - | R2 | Essential |
| 1.12 | Consideration for biopsy must be made in a tumor board/multidisciplinary team meeting before considering radical reirradiation. | 86.6 | 6.7 | 6.7 | R3 | SA |
| 1.13 | Reirradiation can be considered where the tumor board/multidisciplinary team agrees that there is a high likelihood of cancer, but despite best efforts, histologic confirmation of cancer is not possible. | 86.6 | 6.7 | 6.7 | R3 | SA |
| 1.14 | For conventionally fractionated reirradiation, the clinician must consider re-treatment to have a positive risk/benefit ratio considering the current pulmonary function tests and the likely exposure of the lung to reirradiation, with no minimum PFTs values applicable. | 86.6 | 6.7 | 6.7 | R3 | A |
| 1.15 | For reirradiation with SABR, no minimum PFTs apply. | 87 | 0 | 13 | R2 | A |
Abbreviations: ALK = anaplastic lymphoma kinase; CT = computed tomography; D/SD = disagree/strongly disagree; ECOG = Eastern Cooperative Oncology Group; EGFR = epidermal growth factor receptor; MRI = magnetic resonance imaging; N = neutral; PET-CT = positron emission computed tomography; PFT = pulmonary function test; PD-L1 = programmed death-ligand 1; PS = performance status; R2 = round 2; R3 = round 3; SA/A = strongly agree/agree.