Addressing Complexities in Reirradiation Through a Standardised Pathway

Improvements in cancer survival have led to more patients requiring radiotherapy within or near previously irradiated regions. Despite advances in diagnostic imaging, image guidance and highly conformal delivery techniques, reirradiation remains complex because of uncertainties in radiobiology, tissue recovery, dose summation and cumulative organ-at-risk tolerance. We implemented a multidisciplinary workflow to support safe and reproducible reirradiation practice in an Australian radiation oncology department. The pathway defines the roles of radiation oncologists, radiation therapists and radiation oncology medical physicists and integrates biological dose conversion, dose summation strategy selection, tissue recovery assumptions, independent verification and documentation of uncertainty. This article describes the rationale, operational steps and early experience in our department, providing a practical framework for clinical implementation and future audit.