ESTRO clinical practice guideline on high-dose thoracic reirradiation for non-small cell lung cancer
Year: 2026
Type: article
Abstract: PURPOSE: High-dose thoracic reirradiation is increasingly used in clinical practice for patients with non-small cell lung cancer (NSCLC) in a variety of clinical scenarios ranging from locoregional recurrence to selected metastatic settings. The treatment goals of thoracic reirradiation include durable local control, symptom palliation, and potential cure. Despite growing clinical adoption, high-quality randomised evidence guiding patient selection, treatment delivery, and integration with systemic therapy remains limited. This ESTRO- clinical practice guideline aims to provide expert consensus recommendations for high-dose thoracic reirradiation in NSCLC based on the available literature and structured expert agreement. MATERIALS AND METHODS: The guideline was developed by an international, interdisciplinary panel of experts in thoracic radiation oncology and reirradiation, including specialists in radiation oncology, clinical oncology, and medical physics from Europe and North America. A structured modified Delphi consensus process was used to derive and refine recommendations and statements addressing predefined key clinical questions covering patient selection, diagnostic workup, target definition, dose and fractionation, treatment planning and delivery, cumulative dose assessment, combination with systemic therapy, and follow-up. RESULTS: A total of 42 consensus recommendations and statements were derived across eight key questions. Recommendations emphasise careful patient selection, comprehensive staging, precise target delineation integrating prior treatment data, and individualized dose and fractionation balancing tumour control with cumulative organ at risk constraints. Highly conformal image-guided techniques and structured cumulative dose assessment were considered essential for safe delivery. Guidance on combining reirradiation with systemic therapy remains conditional due to limited evidence, and standardised follow-up strategies were proposed to monitor side effects and disease control. CONCLUSIONS: This ESTRO guideline provides consensus-based recommendations to inform clinical practice for high-dose thoracic reirradiation in NSCLC and is intended to complement existing consensus documents addressing technical, methodological, and workflow aspects of reirradiation. In the absence of robust prospective data, these recommendations support multidisciplinary decision-making while highlighting priorities for future clinical research.
Source: Radiotherapy and Oncology
Authors: Nicolaus Andratschke, Jonas Willmann, Edy Ippolito, Carlo Greco, Robert Rulach, Eliana Vasquez Osorio, Andreas Rimner, Cecile Le Pechoux, Jose Belderbos, Max Dahele, Matthias Guckenberger, Gerard Hanna, Paul Van Houtte, Yolande Lievens, Ursula Nestle, David A. Palma, Christoph Pöttgen, Sara Ramella, Ahmed Salem, Helen Grimes, Tina Schytte, Joost J Nuyttens, Clara Chan, Stephen Harrow, Charles B. Simone, Umberto Ricardi
Institutions: University of Zurich, University Hospital Zurich, Università Campus Bio-Medico, Campus Bio Medico University Hospital, University of Oxford, University of Glasgow, University of Manchester, The Christie NHS Foundation Trust, University of Freiburg, Institut Gustave Roussy, The Netherlands Cancer Institute, Amsterdam University Medical Centers, Trinity College Dublin, Université Libre de Bruxelles, Institut Jules Bordet, Ghent University Hospital, Kliniken Maria Hilf, Western University, London Health Sciences Centre, University College London Hospitals NHS Foundation Trust, University of Southern Denmark, Odense University Hospital, Erasmus MC Cancer Institute, The Christie Hospital, NHS Lothian, Western General Hospital, Memorial Sloan Kettering Cancer Center, New York Proton Center, University of Turin
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,770
OpenAlex ID: W7169592356