SU-E-T-747: The Use of the EQD2 Formalism and Repair Estimates in the Re-Irradiation Setting and Correlation with Patient Follow-Up Data

Purpose: Medical advances have resulted in cancer patients living longer as evidenced by the number of patients seen for possible re-irradiation. Original normal tissue dose volume constraints remain in the re-irradiation setting to minimize normal tissue toxicity. This work correlates estimates of equivalent dose and repair with sequelae. Methods: CNS and GI tract re-irradiation patient follow-up records (including imaging studies) were reviewed with side effects correlated with the calculated EQD2 and repair estimates. Results: Follow-up records for 16 re-irradiation patients with potential overlap to the spinal cord were analyzed. The mean time interval between 1st and last courses was 76.6 months. Three patients underwent a 3rd course of radiotherapy with a mean time interval between 2nd and final courses of 19.7 months. The mean values for assumed repair were 18.8% and 8.3%, respectively. The calculated total EQD2 doses were 48.09Gy and 50.98Gy with and without repair. At a mean follow-up time of 5.0 months, 6 patients were deceased and no records indicate radiation related neurological deficits. The records for 11 patients with potential overlap to the bowel were also analyzed. The mean time interval between 1st and last courses was 105.9 months. The mean value for assumed repair was 15.9%. The calculated total EQD2 doses were 64.96Gy and 70.80Gy with and without repair. At a mean follow-up time of 4.9 months, 6 patients were deceased, one having a potential enteric fistulization of the bladder. Clinical review of the case determined that the fistula was caused by tumor progression and not a side effect of radiotherapy treatments. Conclusion: Application of the EQD2 method in the re-irradiation setting using conservative estimates of repair is presented. Adhering to accepted dose volume limits following this application is demonstrated to be safe through empirical records as limited by this small patient cohort and short follow-up