Re-irradiation
Giving radiotherapy again to a region that has already been treated, once thought impossible because normal tissues remember the first dose. Modern precision techniques make it feasible in selected patients.
Recurrent head and neck cancer, glioma, rectal cancer and spinal metastases are the main settings. Cumulative dose to critical structures (spinal cord, brainstem, bowel) limits what can be given, so SBRT, IMRT, protons and brachytherapy, which spare surrounding tissue, are preferred, and the interval since the first course matters as some recovery occurs. Toxicity (necrosis, fistula, carotid blow-out in the neck) is higher than for first treatment, so re-irradiation is often combined with or replaced by surgery or systemic therapy when possible.
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