Modern Radiation Therapy on Refractory Cancer Treatment: Technological Innovations, New Paradigms, Personalized Medicine and Recent Clinical Advances

Dear Colleagues,

Radiation therapy has advanced substantially over the past decade. Improved understanding of tumor biology, emerging platforms such as proton minibeam and synchrotron microbeam radiation, and new paradigms including photon and charged particle spatially fractionated radiation therapy and FLASH therapy have expanded treatment options, increased therapeutic potential, and improved outcomes. Together with adaptive therapy, immunotherapy, and personalized care, these innovations have reportedly enhanced local tumor control, quality of life, and the overall cancer care experience for patients and caregivers—particularly for cancers once considered refractory and associated with poor outcomes using traditional approaches. However, these technologies and their optimal clinical use are still evolving. How and when they should be used alone or in combination with other therapies for eligible cancers and patients remain under investigation, and many techniques are not yet standardized.

Among them, Minibeam, microbeam, and spatially fractionated radiotherapy (SFRT) are innovative approaches that deliver highly focused, spatially separated high-dose radiation to selected tumor subvolumes. FLASH therapy modulates dose delivery over an ultra-short time scale, targeting cancer cells within milliseconds before they can initiate repair signaling. These radiation delivery strategies may promote immune cell infiltration within irradiated tumors, enhance antigen presentation, and activate systematic responses in the target volume as well as in adjacent tissues through bystander and abscopal effects. Personalized radiation therapy can further optimize treatment response for each tumor’s unique characteristics.

This research topic, “Modern Radiation Therapy on Refractory Cancer Treatment: Technological Innovations, New Paradigms, Personalized Medicine and Recent Clinical Advances,” aims to highlight advances in physics, biology, and clinical practice while exploring underlying mechanisms and identifying key knowledge gaps.

We welcome contributions on:

1. Basic, translational, and clinical research on adaptive therapy guided by tumor geometry, biology, and treatment response.
2. Studies examining how different techniques including SFRT, minibeam, microbeam, FLASH, adaptive therapy, personalized treatment, and related approaches and their dose distributions trigger local and systemic responses.
3. Advances in radiation delivery physics and related biological investigations.
4. New strategies for combining techniques to maximize therapeutic outcomes.

Dr. Hualin Zhang
Guest Editor

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