Spanish Society for Radiation Oncology and Spanish Society of Medical Physicists recommendations on reirradiation in gynecological cancer: reirradiation techniques, survival outcomes, dose, and toxicity

Abstract

Reirradiation in gynecological cancer presents significant clinical challenges due to the complexities of prior treatments and anatomical constraints. In response to the lack of standardized protocols, a Delphi-based consensus was conducted by the GINECOR group of the Spanish Society of Radiation Oncology (SEOR) and the Spanish Society of Medical Physics (SEFM). A multidisciplinary panel of radiation oncologists and medical physicists developed expert-based recommendations through a structured tow-round process. Key findings emphasize the pivotal role of brachytherapy for central and vaginal recurrences and support the use of stereotactic body radiation therapy (SBRT) for nodal disease. Other modalities such as intraoperative radiotherapy and proton therapy are considered in specialized settings. The consensus highlights the importance of individualized treatment planning, especially regarding cumulative dose constraints and organ-at-risk tolerance. Futhermore, it underscores the need for further research and prospective clinical trials to refine treatment indications and optimize outcomes in this clinical context.

Keywords: Brachytherapy; Gynecological cancer; Radiotherapy; Reirradiation; SBRT.