{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:58:35Z","timestamp":1790618315515,"version":"4.1.0"},"reference-count":60,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>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. Results: Cumulative dose is an estimate with inherent uncertainty whose clinical value depends on the clinical question, anatomic stability, tissue correspondence, dose-transfer method, biological assumptions, and the consequence of error. Published cumulative dose constraints can provide useful orientation, but they are not universal pass\/fail thresholds and should be interpreted together with their original endpoints, assumptions, and accumulation method. Conclusions: A focused, risk-adapted workflow can support more defensible use of cumulative dose in lung re-irradiation. Practical considerations in this article are intended to complement formal consensus guidance, institutional protocols, or patient-specific multidisciplinary judgment.<\/jats:p>","DOI":"10.3390\/jcm15197527","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T16:50:54Z","timestamp":1790614254000},"page":"7527","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dose Mapping and Accumulation for Re-Irradiation of Lung Cancers: Methodological Principles, Uncertainties, Quality Assurance, and Practical Clinical Considerations"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0732-4115","authenticated-orcid":false,"given":"Mihaela","family":"Rosu-Bubulac","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Virginia Commonwealth University, 1001 East Leigh Street Rm 3-089, Richmond, VA 23219, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3519-0815","authenticated-orcid":false,"given":"Hualiang","family":"Zhong","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Medical College of Wisconsin, 8701 W Watertown Plank Rd., Milwaukee, WI 53226, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indrin Julian","family":"Chetty","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Cedars-Sinai Medical Center, 8700 Beverly Boulevard North Tower Lower Level, Los Angeles, CA 90048, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/1748-717X-9-210","article-title":"Stereotactic body radiation therapy (SBRT) for lung cancer patients previously treated with conventional radiotherapy: A review","volume":"9","author":"Amini","year":"2014","journal-title":"Radiat. 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