Supplementary Material for: Re-irradiation after radical dose radiotherapy: a case report challenging an established dogma.

Traditionally, external beam radiation therapy has a dogma pronouncing that re-irradiation of a region previously exposed to radical dose radiotherapy is contraindicated due to unacceptable risk to surrounding tissues. This edict is often zealously maintained to the detriment of certain, carefully selected patients that may benefit from re-irradiation. Liposarcoma is a high-grade malignancy with a poor prognosis and high rates of recurrence. A case is described of multiply recurrent liposarcoma that we treated with re-irradiation of an extended field encompassing the gross recurrent tumor mass and including the previously irradiated region. The patient had a very good cosmetic outcome and remained disease free after three years of follow up. The case demonstrates the potential to significantly improve patient care if established dogmas are challenged related to the re-irradiation of recurrent high-grade tumors. We propose that with careful patient selection re-irradiation can be delivered safely to patients with recurrent tumors and contribute to improved clinical outcomes.