Personalised radiation therapy taking both the tumour and patient into consideration

A look through almost 2000 abstracts submitted for the upcom-
ing ESTRO 2022 meeting together with a glance back on the 2021
papers published in Radiotherapy and Oncology gives one a good
impression of the (current) key focus areas in radiation oncology:
Almost all of this work relates to optimal delivery of radiation ther-
apy in terms of technology, quality assurance and morbidity reduc-
ing approaches. Thus, at present the research questions considered
as most relevant for radiotherapy of e.g. lung and oesophageal can-
cer are not related to tumour control, but to the late risk of cardiac
disease in the patients who are lucky to survive their cancer long
enough to develop such problems [1]. The same scenario is found
in the patient cohort that constitutes the largest indication for
radiotherapy in Europe: women with early breast cancer [2]. In
these examples, and in many other situations where radiotherapy
is applied with a curative intent, less focus has currently been
given to the aim or indication of the treatment, namely the control
of loco-regional malignant disease. Of course, since Holthusen’s
seminal paper in 1936 [3] the overall aim of radiotherapy, as stated
over and over again by all teachers in the field (including the
authors of this editorial), is uncomplicated tumour control, i.e.
loco-regional tumour control without severe normal tissue damage
(therapeutic ratio). This implies that rigorous study of the effects of
radiotherapy on normal, non-tumour, tissues is an absolute necessity. Yet, the prescription of radiotherapy in clinical practice is
done to kill tumour cells for local and loco-regional control. If the
effects of radiotherapy on tumours are shifting out of focus, it
might be taken for granted that the indication, dose, fractionation,
and potential multidisciplinary interactions in this field are fully
understood, and what remains is the fine tuning of the associated
risk of morbidity.