How do you evaluate and constrain the cumulative lung DVH for inoperable patients who have received multiple courses of lung SBRT and now require fractionated mediastinal RT?

Is your approach to simply calculate the EQD2 for specific lung constraints from the prior SBRT and add to the current plan to use cumulative standard fractionation constraints?

Any practical guideline to estimate the recovery of normal lung tissue with time and potentially forgive some of the prior dose?

Answer from: Radiation Oncologist at Community Practice

This is an increasingly common problem and there are few data to guide decision making.However, some have looked at dosimetric-toxicity relationships in the reirradiation setting (either re-SABR or conventional radiation after SABR).It's suggested that composite high dose to a previously irradiated ...

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Radiation Oncologist at University of Florida Health Proton Therapy Institute
Also, I would be most careful about the major vess...

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How do you evaluate and constrain the cumulative lung DVH for inoperable patients who have received multiple courses of lung SBRT and now require fractionated mediastinal RT?

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