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Personalized Radiotherapy in Cancer Care (2nd Edition)
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Personalized Radiotherapy in Cancer Care (2nd Edition)

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Methods and Technologies Development".

Deadline for manuscript submissions: 31 August 2026 | Viewed by 9488

Special Issue Editors

Prof. Dr. Bin S. Teh

E-Mail Website
Guest Editor
Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
Interests: innovative radiation oncology technologies; stereotactic radiosurgery; gamma knife; stereotactic body radiation therapy; image-guided radiation therapy; combined immunotherapy and radiotherapy
Special Issues, Collections and Topics in MDPI journals
Dr. Waqar M. Haque

E-Mail Website
Guest Editor
Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
Interests: brachytherapy; breast cancer; radiation oncology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue is the second edition of “Personalized Radiotherapy in Cancer Care”.

In 2004, the 21-gene recurrence score (RS) was established as the first predictive gene test for patients with hormonal receptor-positive, HER-2 negative breast cancer who would not benefit from chemotherapy. Since then, numerous predictive biomarkers have been discovered, which has allowed treatments to be tailored to patients to offer the best chance of survival, while also minimizing treatment-related toxicity. While many of the new predictive biomarkers involve modified systemic therapy, the focus is now on optimizing radiation treatments. Predictive genetic tests and the presence of biomarkers are being studied to optimize radiation doses and volumes. This Special Issue hopes to highlight the current status and future plans of personalized radiation therapy for patients with cancer at different disease sites.

Prof. Dr. Bin S. Teh
Dr. Waqar M. Haque
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • predictive biomarkers
  • treatment-related toxicity
  • radiation treatments
  • radiation dose and volume
  • personalized radiation therapy

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Related Special Issue

Published Papers (6 papers)

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13 pages, 675 KB  
Article
OSIRIS-Nose: Organ Sparing Using Interventional Radiotherapy (Brachytherapy) for Invasive Squamous Cell Cancer of the Nasal Vestibule
by Tamer Soror, Pierre-Alexander Justenhoven, Warren Bacorro, György Kovács, Dirk Rades, Karl-Ludwig Bruchhage and Anke Leichtle
Cancers 2026, 18(5), 883; https://doi.org/10.3390/cancers18050883 - 9 Mar 2026
Viewed by 388
Abstract
Background/Objectives: Squamous cell carcinoma of the nasal vestibule (SCCNV) represents a rare malignancy traditionally managed by radical surgical resection, frequently at the cost of substantial functional impairment and disfiguring aesthetic consequences. This study investigates an organ-preserving therapeutic strategy integrating high-dose-rate interventional radiotherapy [...] Read more.
Background/Objectives: Squamous cell carcinoma of the nasal vestibule (SCCNV) represents a rare malignancy traditionally managed by radical surgical resection, frequently at the cost of substantial functional impairment and disfiguring aesthetic consequences. This study investigates an organ-preserving therapeutic strategy integrating high-dose-rate interventional radiotherapy (HDR-IRT; brachytherapy) with organ-preserving surgery. Material and Methods: A retrospective analysis of patients with primary SCCNV treated using HDR-IRT between 2008 and 2022, excluding recurrent disease and cutaneous squamous cell carcinomas. Interstitial HDR-IRT catheters were implanted intraoperatively, with radiation delivered twice daily to a target volume encompassing the tumor and a 10–15 mm safety margin. Results: Fifty-one patients were included, with a median age of 71 years. The median total dose was 40 Gy. Gross total resection was performed in 7 patients, and subtotal resection in 44. The median follow-up was 35 months. The 5-year nose preservation rate was 90%, with local control at 84%, regional failure-free survival at 94%, and overall survival at 82%. In total, 49 acute toxicity events were documented, including two grade 3 events, while 35 chronic toxicity events were reported, including one grade 3 event. At 3 years, 84.3% of cosmetic outcomes were rated as satisfactory, 9.8% as acceptable, and 5.9% as unsatisfactory. Conclusions: The OSIRIS approach, combining HDR-IRT with organ-preserving surgery, is an effective treatment for SCCNV, offering high organ preservation and favorable long-term disease control, with manageable toxicity and positive cosmetic outcomes. Full article
(This article belongs to the Special Issue Personalized Radiotherapy in Cancer Care (2nd Edition))
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16 pages, 5092 KB  
Article
Evaluating Adjuvant Radiation Therapy Survival Benefit in Early-Stage HER2-Positive Invasive Breast Cancer Following Breast-Conserving Surgery: A National Cohort Aligned with NRG-BR008 HERO Trial
by Jonathon S. Cummock, Ali J. Haider, Mohummad Kazmi, Waqar M. Haque, Andrew M. Farach, E. Brian Butler and Bin S. Teh
Cancers 2026, 18(3), 352; https://doi.org/10.3390/cancers18030352 - 23 Jan 2026
Viewed by 939
Abstract
Background and purpose: The role of adjuvant radiation therapy (RT) in early-stage HER2-positive breast cancer treated with breast-conserving surgery (BCS) and systemic therapy remains uncertain in the era of HER2-targeted regimens. This study evaluates the survival impact of RT in patients aligned with [...] Read more.
Background and purpose: The role of adjuvant radiation therapy (RT) in early-stage HER2-positive breast cancer treated with breast-conserving surgery (BCS) and systemic therapy remains uncertain in the era of HER2-targeted regimens. This study evaluates the survival impact of RT in patients aligned with the HERO RT de-escalation trial (NRG-BR008). Materials and methods: We queried the National Cancer Database for patients with early-stage HER2-positive invasive breast carcinoma treated with BCS and systemic therapy, stratified into HERO trial-aligned cohorts: Arm 1 (adjuvant systemic therapy) vs. Arm 2 (neoadjuvant systemic therapy, pathologic complete response). Within each cohort, patients receiving adjuvant RT were compared with those omitting RT. In the primary analysis, patients were propensity score matched (PSM) on demographics, diagnosis years, tumor characteristics, and trial stratification variables. Inverse probability of treatment weighting (IPTW) was additionally performed as a sensitivity analysis. Overall survival was evaluated using Kaplan–Meier, Cox regression, and restricted mean survival time (RMST). Results: In Arm 1 (818 patients, 94 deaths), 5-year OS was 96.9% with RT vs. 88.0% without RT, and 10-year OS was 94.3% vs. 68.5% (log-rank p < 0.001). RT omission was associated with higher mortality in the PSM Cox model (HR, 4.78; 95% CI, 2.84–8.02; p < 0.001), with an RMST advantage favoring RT of +2.86 months at 5 years and +12.55 months at 10 years (p < 0.001). In Arm 2 (176 patients, 10 deaths), 5-year OS was 97.6% with RT vs. 91.1% without RT, and OS at 107 months was 94.8% vs. 91.1% (log-rank p = 0.13). RT omission was not statistically significant in the PSM Cox model (HR, 3.40; 95% CI, 0.82–14.05; p = 0.09), though RMST favored RT (+1.83 months at 5 years, p = 0.004; +3.91 months at 107 months, p = 0.03). IPTW analyses were directionally consistent in Arm 1 (HR, 3.26; 95% CI, 2.52–4.21; p < 0.001) and inconclusive in Arm 2 (HR, 1.78; 95% CI, 0.80–3.95; p = 0.16). Conclusions: In this HERO-aligned national cohort, RT omission was associated with inferior OS in patients treated with adjuvant systemic therapy after BCS. Findings in the neoadjuvant pCR cohort were imprecise and hypothesis-generating. Given the retrospective registry design, lack of recurrence-specific endpoints, and potential residual confounding, results should not be interpreted as causal but support continued RT use outside prospective de-escalation trials. Full article
(This article belongs to the Special Issue Personalized Radiotherapy in Cancer Care (2nd Edition))
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15 pages, 2728 KB  
Article
Single-Fraction SBRT for Locally Advanced Pancreatic Cancer Using Total Intravenous Anaesthesia and Optical Surface Guidance: Technique and Preliminary Results
by Hrvoje Kaučić, Maja Karaman Ilić, Domagoj Kosmina, Ana Mišir Krpan, Sunčana Divošević, Asmir Avdičević, Hrvoje Feljan, Matea Lekić, Karla Schwarz and Dragan Schwarz
Cancers 2025, 17(19), 3093; https://doi.org/10.3390/cancers17193093 - 23 Sep 2025
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Abstract
Background: The aim of this retrospective, single-arm study was to present the technique and preliminary efficacy and safety results of a single-fraction SBRT for LAPC using total intravenous anaesthesia and optical surface guidance as motion management. Methods: Fifty-five patients with locally advanced pancreatic [...] Read more.
Background: The aim of this retrospective, single-arm study was to present the technique and preliminary efficacy and safety results of a single-fraction SBRT for LAPC using total intravenous anaesthesia and optical surface guidance as motion management. Methods: Fifty-five patients with locally advanced pancreatic cancer were treated with SBRT with a single-fraction receiving a median BED10 = 128.9 Gy. Forty-two patients received systemic treatment. End points were OS, FFLP, PFS, and toxicity. Actuarial survival analysis and univariate analysis were investigated. Results: The median follow-up was 15 months, mean OS was 18 months (95% CI: 16.7 to 19.3), and the one-year FFLP and 1-year OS were 100% and 90.9% (95% CI: ± 1.5%), respectively. Median PFS was 12 months (95% CI: 9.5 to 14.4), and 1-year PFS was 85.5% (95% CI: ± 1.4%). Thirty-five patients (63.6%) were alive at the time of analysis. No acute/late toxicity > G2/G1 was reported. Conclusions: SBRT for LAPC using total intravenous anaesthesia and optical surface guidance presented as an effective and safe treatment with very low toxicity. Full article
(This article belongs to the Special Issue Personalized Radiotherapy in Cancer Care (2nd Edition))
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14 pages, 679 KB  
Article
Enhancing Patient Outcomes in Head and Neck Cancer Radiotherapy: Integration of Electronic Patient-Reported Outcomes and Artificial Intelligence-Driven Oncology Care Using Large Language Models
by ChihYing Liao, ChinNan Chu, TingChun Lin, TzuYao Chou and MengHsiun Tsai
Cancers 2025, 17(14), 2345; https://doi.org/10.3390/cancers17142345 - 15 Jul 2025
Cited by 1 | Viewed by 3519
Abstract
Background: Electronic patient-reported outcomes (ePROs) enable real-time symptom monitoring and early intervention in oncology. Large language models (LLMs), when combined with retrieval-augmented generation (RAG), offer scalable Artificial Intelligence (AI)-driven education tailored to individual patient needs. However, few studies have examined the feasibility and [...] Read more.
Background: Electronic patient-reported outcomes (ePROs) enable real-time symptom monitoring and early intervention in oncology. Large language models (LLMs), when combined with retrieval-augmented generation (RAG), offer scalable Artificial Intelligence (AI)-driven education tailored to individual patient needs. However, few studies have examined the feasibility and clinical impact of integrating ePRO with LLM-RAG feedback during radiotherapy in high-toxicity settings such as head and neck cancer. Methods: This prospective observational study enrolled 42 patients with head and neck cancer undergoing radiotherapy from January to December 2024. Patients completed ePRO entries twice weekly using a web-based platform. Following each entry, an LLM-RAG system (Gemini 1.5-based) generated real-time educational feedback using National Comprehensive Cancer Network (NCCN) guidelines and institutional resources. Primary outcomes included percentage weight loss and treatment interruption days. Statistical analyses included t-tests, linear regression, and receiver operating characteristic (ROC) analysis. A threshold of ≥6 ePRO entries was used for subgroup analysis. Results: Patients had a mean age of 53.6 years and submitted an average of 8.0 ePRO entries. Frequent ePRO users (≥6 entries) had significantly less weight loss (4.45% vs. 7.57%, p = 0.021) and fewer treatment interruptions (0.67 vs. 2.50 days, p = 0.002). Chemotherapy, moderate-to-severe pain, and lower ePRO submission frequency were associated with greater weight loss. ePRO submission frequency was negatively correlated with both weight loss and treatment interruption days. The most commonly reported symptoms were appetite loss, fatigue, and nausea. Conclusions: Integrating LLM-RAG feedback with ePRO systems is feasible and may enhance symptom control, treatment continuity, and patient engagement in head and neck cancer radiotherapy. Further studies are warranted to validate the clinical benefits of AI-supported ePRO platforms in routine care. Full article
(This article belongs to the Special Issue Personalized Radiotherapy in Cancer Care (2nd Edition))
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17 pages, 3510 KB  
Article
The Role of Gamma Knife Surgery in the Treatment of Rare Sellar Neoplasms: A Report of Nine Cases
by Michele Longhi, Riccardo Lavezzo, Valeria Barresi, Giorgia Bulgarelli, Anna D’Amico, Antonella Lombardo, Emanuele Zivelonghi, Paolo Maria Polloniato, Giuseppe Kenneth Ricciardi, Francesco Sala, Angelo Musumeci, Giampietro Pinna and Antonio Nicolato
Cancers 2025, 17(9), 1564; https://doi.org/10.3390/cancers17091564 - 3 May 2025
Viewed by 1953
Abstract
Introduction: The group of so-called “sellar-region masses” consists of a heterogeneous group of neoplasms and tumor-mimicking lesions, whose differential diagnosis may be challenging due to the overlapping of clinical and radiological features, which can be found both in “common” and “uncommon” lesions. The [...] Read more.
Introduction: The group of so-called “sellar-region masses” consists of a heterogeneous group of neoplasms and tumor-mimicking lesions, whose differential diagnosis may be challenging due to the overlapping of clinical and radiological features, which can be found both in “common” and “uncommon” lesions. The choice of a correct treatment strategy is still arduous and requires histological analysis. Gamma Knife Radiosurgery (GKRS) has already been reported as a safe and effective treatment in these cases. The objective of this study is to evaluate single-center pre-operative data, post-operative outcomes, and long-term follow-up in patients treated with GKRS for unusual sellar tumors. Methods: We retrospectively identified and analyzed nine patients treated with GKRS from 2004 to 2015, according to a standard protocol. Lesions consist of hypothalamic hamartoma (HH), Rathke’s cleft cist (RCC), Langerhans cell histiocytosis (LCH), spindle cell oncocytoma (SCO), choroid plexus papilloma (CPP), and ossifying fibroma (OF). The diagnosis was histologically confirmed in six patients that underwent surgery, while in three patients, diagnosis was based on characteristic clinical and radiological findings (two HH and one RCC). Pre-operative and post-operative data were retrieved from medical archives, and long-term follow-up was obtained through clinical and neuroradiological periodic examination. Results: In our series, all the “rare” sellar lesions treated, had a successful radiographic and clinical response in a medium-long follow-up period. Conclusions: The long-term follow-up results suggest that GKRS is a safe and effective treatment in rare sellar lesions, with very low toxicity. To the best of our knowledge, this report represents the largest series of unusual sellar lesions treated with GKRS in a single high-volume center, suggesting that GKRS might be an effective non-invasive adjuvant treatment option. Further studies and a larger number of patients are needed to confirm if residuals of these rare sellar lesions might regress on their own without treatment or if other non-invasive treatments could be as effective as GKRS. Full article
(This article belongs to the Special Issue Personalized Radiotherapy in Cancer Care (2nd Edition))
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20 pages, 3177 KB  
Systematic Review
Risk of Radiation-Associated Contralateral Breast Cancer in Germline Mutation Carriers: A Meta-Analysis and Systematic Review
by Christina Hari Nawangsih Prihharsanti, Yan Wisnu Prajoko, Danendra Rakha Putra Respati, Kevin Christian Tjandra, Fitri Mutmainnah, Maritza Bintang Rismadha, Annisa Salsabilla Dwi Nugrahani, Davendra Putra Aryasatya, Andrea Valerie Manik, Fahrul Nurkolis and Edward Kurnia Setiawan Limijadi
Cancers 2026, 18(7), 1106; https://doi.org/10.3390/cancers18071106 - 29 Mar 2026
Viewed by 581
Abstract
Background/Objectives: Contralateral breast cancer (CBC) is a significant concern among breast cancer survivors, particularly in those with moderator-high penetrance germline mutations such as BRCA1, BRCA2, CHEK2, and ATM. While radiotherapy (RT) is a crucial component of breast cancer (BC) treatment, its potential [...] Read more.
Background/Objectives: Contralateral breast cancer (CBC) is a significant concern among breast cancer survivors, particularly in those with moderator-high penetrance germline mutations such as BRCA1, BRCA2, CHEK2, and ATM. While radiotherapy (RT) is a crucial component of breast cancer (BC) treatment, its potential role in increasing CBC risk remains unclear. This systematic review and meta-analysis aim to evaluate the incidence of radiation-induced CBC in germline mutation carriers. Methods: Following PRISMA guidelines, we conducted a comprehensive search in six electronic databases (PubMed, Scopus, Cochrane Library, ProQuest, EBSCO, and Epistemonikos) for studies published fifteen years prior, up to August 2025. We included cohort and case–control studies assessing the association between RT and CBC incidence in germline mutation carriers. A meta-analysis was performed using a random-effects model to estimate cumulative risk (CR) and rate ratios (RR). Results: Seven studies were included. The 5-year cumulative risk (CR) of contralateral breast cancer (CBC) was 0.55 for BRCA1/2, 0.89 for ATM, and 0.80 for CHEK2 carriers. At 10 years, overall CR increased to 0.65, with ATM and CHEK2 remaining high. Rate ratio (RR) analysis showed a significant risk for ATM (2.98), while overall RR indicated more than a two-fold increased CBC risk with radiotherapy (RR = 2.70 common-effect; 2.53 random-effects). Conclusions: Radiotherapy significantly increases contralateral breast cancer risk, particularly in ATM and CHEK2 carriers, emphasizing the importance of personalized genetic risk stratification in treatment decisions. Full article
(This article belongs to the Special Issue Personalized Radiotherapy in Cancer Care (2nd Edition))
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