Here’s a multidisciplinary international expert consensus on thoracic reirradiation. In it you’ll find recommendations on careful patient selection with biopsy confirmation of recurrence whenever feasible and attention to baseline pulmonary reserve. Ablative radiation with BED₁₀ ≥100 Gy (e.g., 54Gy in 3 fractions) is preferred for peripheral tumors <5 cm. For central tumors, moderate hypofractionation such as 55 Gy in 20 fractions is typically suitable with repeat conventional fractionation reserved for patients receiving concurrent chemo–which may improve local control and survival in selected locoregional recurrences but increases risk of severe toxicity (read: esophagitis). Data supporting immunotherapy with reirradiation remain limited, with reported severe/fatal toxicity rates of 7–9%, leading to preference for sequential rather than concurrent regimens. | Andratschke, Radiother Oncol 2026
