Dose Mapping and Accumulation for Re-Irradiation of Lung Cancers: Methodological Principles, Uncertainties, Quality Assurance, and Practical Clinical Considerations.
- 1Department of Radiation Oncology, Virginia Commonwealth University, 1001 East Leigh Street Rm 3-089, Richmond, VA 23219, USA.
- 2Department of Radiation Oncology, Medical College of Wisconsin, 8701 W Watertown Plank Rd., Milwaukee, WI 53226, USA.
- 3Department of Radiation Oncology, Cedars-Sinai Medical Center, 8700 Beverly Boulevard North Tower Lower Level, Los Angeles, CA 90048, USA.
Abstract
Background/Objectives: Thoracic re-irradiation is increasingly considered for recurrent, persistent, or new lung cancers after prior radiation therapy. The central clinical-technical challenge is relating prior and prospective doses across changes in anatomy, breathing state, fractionation, and imaging. Methods: This clinical-technical Perspective synthesizes consensus guidance, technical and the methodological literature, and representative clinical evidence to discuss rigid and deformable registration, dose mapping, biological normalization with EQD2/BED, uncertainty, quality assurance, and practical decision-making in lung re-irradiation. Results: Cumulative dose is an estimate with inherent uncertainty whose clinical value depends on the clinical question, anatomic stability, tissue correspondence, dose-transfer method, biological assumptions, and the consequence of error. Published cumulative dose constraints can provide useful orientation, but they are not universal pass/fail thresholds and should be interpreted together with their original endpoints, assumptions, and accumulation method. Conclusions: A focused, risk-adapted workflow can support more defensible use of cumulative dose in lung re-irradiation. Practical considerations in this article are intended to complement formal consensus guidance, institutional protocols, or patient-specific multidisciplinary judgment.
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BibTeX
@article{rosububulac2026dose,
title = {{Dose Mapping and Accumulation for Re-Irradiation of Lung Cancers: Methodological Principles, Uncertainties, Quality Assurance, and Practical Clinical Considerations.}},
author = {Mihaela Rosu-Bubulac and Hualiang Zhong and Indrin Julian Chetty},
journal = {Journal of clinical medicine},
year = {2026},
month = sep,
doi = {10.3390/jcm15197527},
url = {https://europepmc.org/article/MED/42881989},
note = {CC BY},
}
RIS
TY - JOUR
TI - Dose Mapping and Accumulation for Re-Irradiation of Lung Cancers: Methodological Principles, Uncertainties, Quality Assurance, and Practical Clinical Considerations.
AU - Mihaela Rosu-Bubulac
AU - Hualiang Zhong
AU - Indrin Julian Chetty
PY - 2026
DA - 2026/09/28
JO - Journal of clinical medicine
DO - 10.3390/jcm15197527
UR - https://europepmc.org/article/MED/42881989
AB - Background/Objectives: Thoracic re-irradiation is increasingly considered for recurrent, persistent, or new lung cancers after prior radiation therapy. The central clinical-technical challenge is relating prior and prospective doses across changes in anatomy, breathing state, fractionation, and imaging. Methods: This clinical-technical Perspective synthesizes consensus guidance, technical and the methodological literature, and representative clinical evidence to discuss rigid and deformable registration, dose mapping, biological normalization with EQD2/BED, uncertainty, quality assurance, and practical decision-making in lung re-irradiation. Results: Cumulative dose is an estimate with inherent uncertainty whose clinical value depends on the clinical question, anatomic stability, tissue correspondence, dose-transfer method, biological assumptions, and the consequence of error. Published cumulative dose constraints can provide useful orientation, but they are not universal pass/fail thresholds and should be interpreted together with their original endpoints, assumptions, and accumulation method. Conclusions: A focused, risk-adapted workflow can support more defensible use of cumulative dose in lung re-irradiation. Practical considerations in this article are intended to complement formal consensus guidance, institutional protocols, or patient-specific multidisciplinary judgment.
SN - 2077-0383
ER -