Temporally Corrected Dose Accumulation -- Next Steps in the Biology of Reirradiation

IntroductionTreatments encompassing multiple courses of radiation are becoming increasingly common in the management of oligometastatic disease, offering opportunities to extend progression-free and overall survival. However, a major challenge in clinical practice is the lack of standardized methods to assess and mitigate toxicity risks associated with successive radiation treatments. Furthermore, normal tissue recovery post-radiation remains poorly characterized, and the absence of standardized documentation for radiotherapy history complicates large-scale research efforts. To address these limitations, we propose the development of a novel DICOM-compatible object for integration into patient medical records. Materials and MethodsWe generated software designs and bundle mathematics that demonstrate the utility of this DICOM object and how various dose forgiveness algorithms can be applied to the data. We include simple linear, exponential, logarithmic, and Gaussian recovery algorithms as well as complex non-linear algorithms based on the literature currently available. ResultsWe applied the tool to an anonymized patient dataset, demonstrating the mathematical analysis applied to the data found in the new DICOM object. Noting ease and efficacy, we demonstrated that, in contrast to the current practice of gathering and structuring information distributed across electronic medical records, ready access to prior radiation courses accomplished two goals. (1) Facilitate data collection and analysis by streamlining access to comprehensive radiotherapy history, enabling researchers to conduct large-scale studies, and ultimately improve our understanding of tissue recovery. (2) Enhance clinical decision-making by enabling clinicians or software tools to leverage this data to personalize treatment plans, support clinical decision making to minimize toxicity risks during re-irradiation. For the anonymized patient, our analysis demonstrates safer delivery of re-radiation plans when viewed in the lens of dose forgiveness. ConclusionsA novel DICOM object which keeps track of radiation treatments enables clinicians to factor tissue recovery and response into planning safer multiple radiation therapy courses and facilitates cross-institution research on re-irradiation and dose forgiveness.