Dose Mapping and Accumulation for Re-Irradiation of Lung Cancers: Methodological Principles, Uncertainties, Quality Assurance, and Practical Clinical Considerations

Background/Objectives: Thoracic re-irradiation is increasingly considered for recurrent, persistent, or new lung cancers after prior radiation therapy. The central clinical-technical challenge is relating prior and prospective doses across changes in anatomy, breathing state, fractionation, and imaging.

Methods

This clinical-technical Perspective synthesizes consensus guidance, technical and the methodological literature, and representative clinical evidence to discuss rigid and deformable registration, dose mapping, biological normalization with EQD2/BED, uncertainty, quality assurance, and practical decision-making in lung re-irradiation.