Top Line: Reirradiation for locally recurrent rectal cancer requires careful planning.
The Study: New ESTRO consensus recommendations provide practical guidance addressing everything from patient selection to treatment planning. Despite mostly low-quality evidence, the panel strongly endorses reirradiation as part of multimodality care for appropriately selected patients. The most agreed upon regimens were 2 Gy x 15 = 30 Gy, 1.5 Gy x 20-26 BID fractions = 30–39 Gy, or 1.2 Gy x 34 BID fractions = 40.8 Gy, all via IMRT/VMAT with daily 3D-image guidance concurrent to 5FU-based chemo when feasible. Ultra-hypofractionated ablative radiation is supported for anatomically-selected (i.e., no bowel or bladder involvement), small (i.e. <5 cm) discrete recurrences, while proton and carbon ion therapy may be considered at experienced centers. Perhaps most emphasized is individualized assessment of cumulative EQD2 to organs at risk balancing local control, resectability, and adverse effects in a multidisciplinary setting rather than relying on rigid dose cutoffs.
TBL: In the setting of modern planning, meticulous cumulative dose assessment, and multidisciplinary deliberation, reirradiation is a standard-of-care component of salvage therapy for locally-recurrent rectal cancer. | Peulen, Radiother Oncol 2026
The Study: New ESTRO consensus recommendations provide practical guidance addressing everything from patient selection to treatment planning. Despite mostly low-quality evidence, the panel strongly endorses reirradiation as part of multimodality care for appropriately selected patients. The most agreed upon regimens were 2 Gy x 15 = 30 Gy, 1.5 Gy x 20-26 BID fractions = 30–39 Gy, or 1.2 Gy x 34 BID fractions = 40.8 Gy, all via IMRT/VMAT with daily 3D-image guidance concurrent to 5FU-based chemo when feasible. Ultra-hypofractionated ablative radiation is supported for anatomically-selected (i.e., no bowel or bladder involvement), small (i.e. <5 cm) discrete recurrences, while proton and carbon ion therapy may be considered at experienced centers. Perhaps most emphasized is individualized assessment of cumulative EQD2 to organs at risk balancing local control, resectability, and adverse effects in a multidisciplinary setting rather than relying on rigid dose cutoffs.
TBL: In the setting of modern planning, meticulous cumulative dose assessment, and multidisciplinary deliberation, reirradiation is a standard-of-care component of salvage therapy for locally-recurrent rectal cancer. | Peulen, Radiother Oncol 2026