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Clinical approaches to re-irradiation in the MENA region: insights from 115 radiation oncologists

Year: 2026

Type: article

Abstract: Background: Re-irradiation is increasingly used in the management of recurrent cancers, yet it remains a technically demanding procedure, particularly in regions with heterogeneous access to radiotherapy resources. The Middle East and North Africa (MENA) region comprises countries with diverse infrastructure, but no multicountry evaluation of re-irradiation practices has previously been conducted. Materials and methods: A 37-item online survey was administered to radiation oncology residents, specialists, and professors from six MENA countries between June 2024 and March 2025. The questionnaire explored clinical exposure to re-irradiation, indications, treatment techniques, dose assessment methods, decision-making criteria, and perceived training needs. Data were analysed using descriptive statistics. Results: A total of 115 clinicians responded. The most frequent indications for re-irradiation were local recurrence (90%) and metastatic disease (67%). Advanced techniques such as IMRT and SBRT were commonly used (87%). Preferred inter-treatment intervals were 6-12 months (35%) and 12-24 months (38%). Cumulative dose and treated volume were identified as key decision-making parameters by most participants (94%). Major challenges included cumulative dose estimation (90%), concerns regarding toxicity (80%), the lack of standardised guidelines (56%), and limited access to advanced planning tools, including deformable image registration. EQD2 was systematically used for biological dose summation by all respondents. Conclusions: This first multicountry assessment from the MENA region reveals considerable variability in re-irradiation practices and underscores gaps in infrastructure, standardisation, and training. These results highlight the need for region-specific guidelines and collaborative efforts to optimise safe and consistent re-irradiation approaches.

Source: Reports of Practical Oncology & Radiotherapy

DOI: 10.5603/rpor.113085