Treatment planning for lung cancer reirradiation accounting for previously delivered dose

Reirradiation is increasingly used for recurrent and new primary cancers, but dedicated planning tools are limited. We integrated deformable image registration and radiobiologically consistent dose accumulation into plan optimisation to improve plan quality and robustness, applying this approach to six lung cancer cases and comparing it with a manual, maximum point-dose method.The integrated automated approach delivered higher target doses within organ-at-risk limits, maintained robustness, and was qualitatively preferable in blinded comparison. It produced clinically acceptable dose distributions for 5/6 patients, versus 3/6 with the manual method, suggesting enhanced and potentially more efficient reirradiation planning.