European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus on re-irradiation: definition, reporting, and clinical decision making

Nicolaus Andratschke*, Jonas Willmann, Ane L. Appelt, Najlaa Alyamani, Panagiotis Balermpas, Brigitta G. Baumert, Coen Hurkmans, Morten Høyer, Johannes A. Langendijk, Orit Kaidar-Person, Yvette van der Linden, Icro Meattini, Maximilian Niyazi, Nick Reynaert, Dirk De Ruysscher, Stephanie Tanadini-Lang, Peter Hoskin, Philip Poortmans, Carsten Nieder

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

5 Citations (Scopus)


Re-irradiation can be considered for local recurrence or new tumours adjacent to a previously irradiated site to achieve durable local control for patients with cancer who have otherwise few therapeutic options. With the use of new radiotherapy techniques, which allow for conformal treatment plans, image guidance, and short fractionation schemes, the use of re-irradiation for different sites is increasing in clinical settings. Yet, prospective evidence on re-irradiation is scarce and our understanding of the underlying radiobiology is poor. Our consensus on re-irradiation aims to assist in re-irradiation decision making, and to standardise the classification of different forms of re-irradiation and reporting. The consensus has been endorsed by the European Society for Radiotherapy and Oncology and the European Organisation for Research and Treatment of Cancer. The use of this classification in daily clinical practice and research will facilitate accurate understanding of the clinical implications of re-irradiation and allow for cross-study comparisons. Data gathered in a uniform manner could be used in the future to make recommendations for re-irradiation on the basis of clinical evidence. The consensus document is based on an adapted Delphi process and a systematic review of the literature was done according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Original languageEnglish
Pages (from-to)e469-e478
JournalThe Lancet Oncology
Issue number10
Publication statusPublished - Oct 2022
Externally publishedYes

Bibliographical note

Funding Information:
ALA acknowledges Cancer Research UK funding (grant C19942/A28832) for the Leeds Radiotherapy Research Centre of Excellence (RadNet; Leeds, UK). NAl's work as Fellow at the European Organisation for Research and Treatment of Cancer Headquarters was supported by a grant from Kom op tegen Kanker (Stand up to Cancer), the Flemish Cancer Society from Belgium, and the EORTC Cancer Research Fund. PH is funded by the NIHR Manchester Biomedical Research Centre.

Funding Information:
NAn reports grants from ViewRay and Brainlab; honoraria for lectures and reimbursement for travel by ViewRay; personal fees from Debiopharm, AstraZeneca, and ViewRay; and non-financial support from ViewRay. BGB reports an honorarium for travel expenses from a Swiss Academy of Multidisciplinary Oncology meeting; participation in the data safety monitoring board or advisory board for the Multicentre BRIOCHE Trial UK (BRIOChe study: Brain Re-Irradiation Or Chemotherapy: a phase 2 trial of re-irradiation or chemotherapy for recurrent glioblastoma) from the University of Leeds (Leeds, UK); is General Secretary in the Scientific Association of Swiss Radiation Oncology board; and a member of the scientific board of Schweizerische Arbeitsgemeinschaft für Klinische Krebsforschung. MH reports an honorarium for giving a lecture at a symposium arranged by Varian in Copenhagen (Denmark), on May 6, 2022. JAL declares research grants by the European Union and the Dutch Cancer Society; consulting fees paid to UMCG Research BV by IBA; and an honorarium for presentations paid to UMCG Research BV by IBA. JAL is Chair of the safety monitoring committee of the UPGRADE trial from the University Medical Center Nijmegen; a member of the global advisory committee at IBA; a member of the RayCare clinical advisory board at RaySearch; and Chair (unpaid) of the Netherlands Society for Radiation Oncology. PP is a medical adviser of Sordina IORT Technologies SpA. ST-L's husband is an employee at Varian. IM declares occasional small fees (consulting fees) from Novartis, Pfizer, Eli Lilly, Seagen, and Accuray; and occasional small fees (payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events) from Novartis, Pfizer, Eli Lilly, and Seagen. MN declares honoraria and speaker fees from Brainlab, and is a member of the advisory board at Novocure. All other authors declare no competing interests.

Publisher Copyright:
© 2022 Elsevier Ltd


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