Year: 2025
Type: article
Abstract: Reirradiation (reRT), defined as administering a course of radiation therapy to a specific area previously irradiated, is an evolving treatment strategy for locoregionally recurrent cancer that offers significant potential and poses inherent challenges. Advances in such techniques as intensity-modulated and stereotactic body radiation therapy have improved precision, making reRT a viable option for complex scenarios previously deemed high-risk. Nevertheless, reRT remains associated with substantial risks-including life-threatening side effects, functional impairments, and psychosocial effects-which must be carefully balanced against the patient's overall health and the likelihood of achieving cancer control or palliation. Patient selection is essential to optimize outcomes while mitigating risks. Decisions should account for tumor characteristics at the time of primary diagnosis and recurrence, elapsed time since prior treatment, the possibility of delivering meaningful doses to the tumor, and the cumulative irradiation tolerance of normal tissues. Advanced imaging modalities, such as functional magnetic resonance imaging and fluorine-18-labeled fluorodeoxyglucose-positron emission tomography, are important for distinguishing recurrences from treatment-induced changes, refining treatment targets, and minimizing exposure to healthy tissue. Combined treatment with systemic regimens-targeted therapies and immunotherapy in particular-offers promising opportunities but requires coordination to manage side effects. Standardized guidelines, such as those from the European Society of Therapeutic Radiology and Oncology-European Society for Research and Treatment of Cancer, are essential for improving the consistency of reporting, guiding clinical decision making, and fostering patient-centered care. Multidisciplinary collaboration and ongoing research, particularly through clinical trials, are central to fully exploiting reRT strategies. In addition, the development of innovative techniques, such as proton therapy, would likely enable safer treatments. These efforts aim to improve the therapeutic balance of reRT, enhancing outcomes and quality of life.
DOI: 10.3322/caac.70016
Authors: Arnaud Beddok, Jonas Willmann, Anna Embring, Ane L. Appelt, Panagiotis Balermpas, Kevin Chua, J. Isabelle Choi, Bernice Simone Elger, Dorota Gabrys, Peter Hoskin, Maximilian Niyazi, David Pasquier, Kelly Paradis, Orit Kaidar‐Person, Corien Plaisier, Nicole C. Schmitt, Conor E. Steuer, Juliette Thariat, Sue S. Yom, Philip Poortmans, Eliana Vasquez Osorio, Nicolaus Andratschke
Institutions: Yale University, Centre de Recherche en Sciences et Technologies de l'Information et de la Communication, Institut Jean Godinot, Université de Reims Champagne-Ardenne, Memorial Sloan Kettering Cancer Center, University of Zurich, University Hospital Zurich, Karolinska University Hospital, Karolinska Institutet, University of Leeds, National University of Singapore, Duke-NUS Medical School, National Cancer Centre Singapore, New York Proton Center, University of Geneva, University of Basel, The Maria Sklodowska-Curie National Research Institute of Oncology, University of Manchester, Mount Vernon Cancer Centre, Universitätsklinikum Tübingen, Université de Lille, Centre Oscar Lambret, Michigan Medicine, Tel Aviv University, Sheba Medical Center, Maastricht University Medical Centre, Maastricht University, Maastro Clinic, Emory University, Winship Cancer Institute, Centre François Baclesse, University of California, San Francisco, University of Antwerp, Iridium Kankernetwerk, National Health Service
Language: English
Subfield: Radiation
Field: Physics and Astronomy
Domain: Physical Sciences
Open Access status: gold
Estimated APC paid: $4,330
OpenAlex ID: W4410865910