Preserving the legacy of reirradiation: A narrative review of historical publications

Abstract

PurposeThe purpose of this study is to illustrate the historical development of reirradiation during several decades of the 20th century, in particular between 1920 and 1960.Methods and materialsWe chose the format of a narrative review because the historical articles are heterogeneous. No systematic extraction of baseline data, treatment details, or follow-up care was possible in many cases.ResultsBoth hematological malignancies and solid tumors were treated with a second course of radiation therapy, and indications included local relapse, regional nodal recurrence, and second primary tumors developing in a previously treated region. The literature consists of retrospective single-institution analyses describing treatment approaches that included external beam radiation therapy, brachytherapy, or combinations thereof. Data on toxicities and survival were often provided. Breast cancer and gynecological, head and neck, brain, and skin tumors are among the entities included in this review.ConclusionsThe leading pioneers in the field are fully aware of many of the challenges we continue to debate today. These include the process of late tissue changes and development of personalized treatment approaches and better ways to select patients who are likely to benefit from a second course of radiation therapy.

Second re-irradiation: a narrative review of the available clinical data

“…Re-irradiation has a surprisingly long track record [1], probably because clinicians involved in cancer care during the first half of the last century were facing a challenging situation. The armamentarium of effective salvage treatment options was limited, while relapse was a common scenario [2].…”

“…Furthermore, external beam treatment machines were not able to deliver a sufficient depth dose without excessive built-up dose in skin and surface-near tissues, while brachytherapy required a set of eligibility criteria, e.g., accessibility and limited tumor stage [4]. Some of the early reports contain brief descriptions of patients who received a third course of radiotherapy to the previously treated region [1]. However, no detailed cumulative doses and outcomes were provided.…”

A Practical Radiotherapy Treatment Planning Technique for Second-Incidence Cancers That Incorporates Complete Organ-At-Risk Dose History

“…Persons who have received radiotherapy treatments and later develop new cancer requiring a second radiotherapy treatment present unique radiotherapy planning challenges [1][2][3][4]. Namely, previous radiation delivered to organs at risk (OARs) must be considered when assessing lifetime toxicity risks.…”

“…Although there are potentially serious consequences of elevated lifetime doses, comprehensive literature concerning second radiotherapy treatmentsdespecially clinical trialsdis limited [4,8,9]. There is no consensus about the most effective clinical procedure to accommodate dosimetric history for normal tissues [2,4,10,11]. Even use of radiotherapy is contentious [11,12].…”

“…This practice discards spatial information, which can result in gross misrepresentation of the NTCP, not to mention compounding issues of fractionation and tissue recovery over time. Historically, maximum point-dose summation was performed because the dose distribution could not be fused, and it remains one of the few viable options when the planning systems used for first and second treatments are generally incompatible (eg, brachytherapy and external beam therapy) [2]. The approach favored by recent treatment planning systems (TPSs) is to use registration to incorporate the historical 3D dose profile into the second treatment planning process [1].…”