A dedicated institutional clinical workflow and peer-review meeting for reirradiation

Sep 28, 2026

Uploaded by Jasmine

Reirradiation (reRT) presents organizational and technical challenges that require standardized, safety-focused practices. The study presents an institutional clinical workflow to systematically manage reRT, including detection and identification in the oncology information system, collection of prior treatment data, overlap and cumulative radiobiological EQD2Gy analysis for organs at risk, and final plan validation using image registration and EQD2Gy dose accumulation. A multidisciplinary peer-review meeting supports the process, and institutional 2020–2023 activity plus a young radiation oncologist survey evaluated effectiveness.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Background and Purpose

Materials and Methods

Results

Conclusions

Technical Innovations & Patient Support in Radiation Oncology 37 (2026) 100366 Contents lists available at ScienceDirect Technical Innovations & Patient Support in Radiation Oncology journal [homepage:](homepage: www.sciencedirect.com/journal/technical-innovations-and)[ www.sciencedirect.com/journal/technical-innovations-and](homepage: www.sciencedirect.com/journal/technical-innovations-and)patient-support-in-radiation-oncology | A dedicated institutional clinical workflow and peer-review meeting for reirradiation☆
Pauline Dupuis a,* , Magali Sandta , Guillaume Beldjoudia , Coralie Moncharmontb, Anne-Agathe Serre b, Line Claude b, Marie-Pierre Sunyach b, Myriam Ayadia
a Centre L´eon B´erard, Department of Medical Physics, 28 rue La¨ennec, 69373 Lyon Cedex 08, France b Centre L´eon B´erard, Department of Radiation Oncology, 28 rue La¨ennec, 69373 Lyon Cedex 08, France | | | | | --- | --- | --- | --- | | A R T I C L E I N F O | | A B S T R A C T | | | Keywords: Reirradiation Clinical workflow Dose accumulation Peer-review meeting | | Background and Purpose: Reirradiation (reRT) is a clinical challenge and requires organisational and technical efforts to standardise and ensure safety of practices. An institutional clinical workflow developed to manage and support systematic approach for patients’ reRT was presented in this work.
Materials and Methods: The workflow included a standardised approach for reRT detection and identification inpatient folder in the oncology information system, previous treatment data collection, pre-treatment planning analysis of overlaps and acceptable cumulative radiobiological equieffective doses (EQD2Gy) to organs at risk, a final validation of new treatment plan using image registration and EQD2Gy dose accumulation, and a multidisciplinary peer review meeting. Statistics were compiled on reRT activity at our institution between 2020 and 2023 and the reRT peer-review meeting and the workflow were assessed through a survey addressed to young radiation oncologists (RO).
Results: During the studied period, 1920 treatments were declared as reRT at our institution. The first reRT site was the brain, followed by spine, thorax and breast. The most commonly used techniques for reRT were stereotactic radiotherapy or volumetric modulated arc therapy. The youngRO survey showed that more than 80% of respondents found a benefit of peer-review meeting, with a particular interest in discussions on cumulative equieffective dose limits and cumulative doses validation. The majority of them declared they gained confidence in their reRT practice.
Conclusions: The implementation of a standardized institutional workflow for reRT management helped harmonize practices within our institution to support our reRT workload. Feedback from young RO highlighted the value of peer-review meetings which contributed to increase their confidence in reRT practices. | | 1. Introduction Indications for reirradiation (reRT) are increasing, due to improvements in patient’s survival and to modern radiotherapy techniques which enable complex dose distributions, sharp dose gradients and organs at risk (OAR) sparing, combined with an accurate patient positioning throughout treatment. Recently, an ESTRO-EORTC joint consensus has given a definition to reRT and provided reporting guidelines for clinical practice and research studies [1]. Despite expert’s consensus on reRT in various anatomical regions are aiding clinical decision making, one of the main clinical challenges in reRT is the lack of evidence and recommendations in tissues tolerances and potential recovery [2,3]. The need for clearly established dose limits is crucial as dose previously delivered to OAR may compromise new target coverage. In parallel, reRT requires a complex management, including previous treatment data collection, assessment of dose to organs at risk (OAR) and dose accumulation strategies [4]. To ensure that cumulative dose to previ

FAQs

What is reirradiation (reRT) and why is it challenging?

Reirradiation (reRT) is a clinical challenge that requires organizational and technical efforts to standardize and ensure patient safety. Key issues include limited evidence and recommendations for tissue tolerances and recovery.

What steps are included in the institutional clinical workflow for reRT?

The workflow covers standardized reRT detection and identification in the oncology information system, collection of previous treatment data, pre-treatment overlap and cumulative radiobiological EQD2Gy analysis for organs at risk, and final validation using image registration and EQD2Gy dose accumulation. It also includes a multidisciplinary peer-review meeting.

How was the workflow and peer-review meeting evaluated, and what were the main findings?

Institutional reRT activity from 2020 to 2023 was compiled, and a survey was sent to young radiation oncologists. More than 80% reported benefit from peer-review meetings, especially for discussions on cumulative EQD2Gy dose limits and cumulative dose validation, and most reported increased confidence in reRT practice.

Sep 28, 2026

Uploaded by Jasmine