Re-irradiation in Gynaecological Malignancies: A Review

Re-irradiation in gynaecological malignancies has become an increasingly frequent consideration. This can be delivered in multiple settings, with the most common being a patient with a history of cervical cancer developing a new vaginal cancer or endometrial cancer with local recurrence after hysterectomy and adjuvant pelvic radiation. A systematic review of the literature has unearthed a handful of reports, most delivering brachytherapy, with a small number on both external beam radiotherapy and stereotactic ablative radiotherapy. A detailed review of these papers suggests that it is not possible to draw any firm conclusions or put forward guidelines for this challenging area of gynaecological oncology. Here the author has provided a brief account of each paper, followed by a discussion of the literature, aiming to outline some very broad principles for management. It is recommended that such patients be referred to centres that treat high volumes of gynaecological malignancies, as the experience of the treating oncologist may be the most important factor in the management of these patients.