Applying Precision Oncology Principles in Radiation Oncology

Sophia C. Kamran; Kent W. Mouw


JCO Precis Oncol 

In This Article

Abstract and Introduction


Radiation therapy is a critical component in the curative management of many solid tumor types, and advances in radiation delivery techniques during the past decade have led to improved disease control and quality of life for patients. During the same period, remarkable advances have also been made in understanding the genomic landscape of tumors; however, treatment decisions in radiation oncology continue to depend primarily on clinical and histopathologic characteristics rather than on the genetic features of the tumor or the patient. With the development of novel genomic techniques and their increasing use in clinical practice, radiation oncology is uniquely positioned to leverage these advances to identify novel biomarkers that could inform radiation dose, field, and the use of concurrent systemic agents. Here, we summarize efforts to use genomic techniques to guide radiation decisions, and we highlight some of the current opportunities and challenges that exist in attempting to apply precision oncology principles in radiation oncology.


Radiation plays a central role in cancer management, and it is estimated that more than half of all patients with cancer will receive radiation therapy during their treatment course.[1] Radiation is used in a variety of clinical contexts, including in the definitive management of several solid tumor types as well as in palliation of symptoms associated with advanced disease.[2]

Many of the changes in radiation oncology in recent decades have been driven by advances in imaging and dosimetry that have resulted in the ability to deliver higher radiation doses to tumor while minimizing the dose to surrounding normal tissue.[3] In contrast, advances in understanding tumor biology and genetics have affected radiation oncology practice less to date, particularly when compared with other oncology specialties.[4,5]

Currently, genomic biomarkers are rarely used to inform the use of radiation therapy. Instead, clinical-pathologic factors, such as tumor size, histology, lymph node involvement, and surgical margin status, continue to drive radiation oncology standards of practice. Thus, although radiation is a precision treatment modality in a spatial and anatomic sense, the potential to incorporate tumor genomic features as a precision tool in radiation oncology has not yet been realized.

Here, we discuss progress toward leveraging genomic insights to inform radiation treatment and highlight areas for future investigation.