Re-irradiation: improving dose summation for plan optimisation, evaluation, and outcomes analysis


Chairs: Ane Appelt (UK), Eliana Vasquez Osorio (UK)

Co-chairs: Andy Jackson (USA), Chuck Mayo (USA)


Re-irradiation deals with a particular set of challenges which require dedicated medical physics expertise and input. These include large – sometimes dramatic – anatomical changes and the need for radiobiological considerations in dose summation. These challenges must be addressed in order to confidently assess cumulative dose and optimise re-irradiation treatment plans.


  • There are few (if any) technical solutions in place in commercial systems, and almost none which have been developed and refined specifically with re-irradiation in mind.
  • There are no common standards for dose assessment and reporting - neither for individual patients in the clinic, for retrospective reports in the literature, nor for prospective clinical trials. 

Currently, re-irradiation in most clinics is still more art than science, and the quality of delivery is down to the skills and preferences of the local team.

Despite this, re-irradiation has seen a surge in use in recent years. A number of ongoing or planned multicentre clinical studies (including the upcoming pan-European E2RADIATE ReCare cohort) will help develop the evidence. If coordinated, studies such as these will provide an opportunity to investigate impact of different approaches to dose accumulation.

This workshop will bring together physicists, computer scientists, and other health professionals with an interest in re-irradiation to discuss the cutting edge of re-irradiation research and clinical implementation. We will seek to answer the questions

  • What are the key technical challenges for re-irradiation dose optimisation and assessment?
  • What should be minimum and optimal reporting standards for cumulative dose in re-irradiation studies?
  • Which tools are currently missing in commercial treatment planning systems to facilitate safe utilisation of re-irradiation?
  • Which data should be shared between between institutions in re-irradiation settings?

Planned outcomes

  • Consensus statement on best practice for dose accumulation in the re-irradiation setting;
  • Recommendations for commercial vendors on which tools and functionality are most urgently needed (“wishlist to vendors”);
  • Statement on information to be provided between institutions in re-irradiation settings;
  • Recommendations to journals for minimal sets of data to be included in publications on experience with re-irradiation;
  • A list of research questions to be explored, with additional funding, in the planned (prospective & retrospective) cohorts.



Pre-meeting online session (7th September, 2:00pm – 4:30pm CEST)


  • Introduction to the workshop & participant introductions
  • Setting the scene

The clinical opportunities and challenges of reirradiation

Managing re-irradiation in the clinic – a physicist perspective

  • Introducing the pre-meeting benchmark survey


In-person programme (7th-8th Oct 2022)

Speakers and discussion chairs will include:

  • Ane Appelt, Leeds, UK (physicist)
  • Eliana Vasquez Osorio, Manchester, UK (computer scientist)
  • Prof Andratschke Nicolaus, Zurich, Switzerland (radiation oncologist)
  • Andrew Jackson, MSKCC, US (physicist)
  • Charles Mayo, Michigan, US (physicist)


7 October 2022 

  • Invited talk: Clinical challenges of re-irradiation – setting up the scene
  • Results of hands-on cases and standard-of-practice survey 
  • Break out group discussions 
  1. Planning and evaluating re-irradiation in the clinic
  2. Collecting and reporting data on OAR doses for outcome/toxicity modelling


8 October 2022 

  • Follow-up on yesterday’s discussions 
  • Invited talk: Opportunities from large scale radiotherapy data collection – European & US perspective
  • Break out group discussions
  1. Deformable image registration for dose accumulation / mapping
  2. Prospective registries and clinical trials
  • Wrap up, preparing take home messages & future plans. Develop “wishlist to vendors” based on all group discussions 


Endorsed by