The Role of Radiation in Cancer Treatment: New Insights towards Personalized Therapies

Dear Colleagues,

At present, radiation therapy (RT) remains an essential component of multimodality approaches for the treatment of many types of cancer, and one of the most effective cancer therapies. Approximately, the 50–60% of all cancer patients will receive RT through several modalities, such as internal or external RT, either alone or in combination with other treatment regimens (i.e., surgery or chemotherapy).

Over the last decade, the technological development of RT has led to the ability to deliver with high precision a specific dose of ionizing radiation (IR) on the tumor target, also thanks to the use of hadrons such as protons and carbon ions, thus limiting the damage to healthy tissues.

Currently, clinical practice still offers standard RT protocols for patients with cancer affecting the same organ, without considering the molecular profile and the tumoral histotype, which may affect the RT outcome. Unfortunately, RT does not always lead to therapeutic benefits, due to distant metastatic spread and local recurrence, which induce radioresistance. Indeed, tumor radiosensitivity depends on many factors, some of which are linked to the clinical state and genetic background of the patient. The balance between radiosensitivity and radioresistance is regulated by different complex factors, including: the tumor stem cells, responsible for cancer repopulation within the RT schedule timespan; tumor-associated microenvironment features, such as hypoxia and the tumor–stroma interaction; an intrinsic and cell-dependent sensitivity to radiation; the modulation of DNA repair or other cell survival pathways in cancer.

In this scenario, the pivotal role of research in the field of radiobiology is to help clinicians in understanding the molecular portrait of a specific cancer type, in order to propose successful combinatorial anticancer therapies in clinical practice. Therefore, in the era of personalized medicine, prognostic and therapy-predictive molecular biomarkers are required to guide cancer therapeutic decisions between different RT modalities and schedules.

Thanks to high-throughput omics approaches such as proteogenomics, metabolomics, epigenomics, and radiomics, new instruments are now available for the diagnosis, to monitor the disease progression, and to predict radiosensitivity in many cancer types.

This Special Issue aims to provide new insights into the role of RT in different types of cancer in order to develop personalized therapies, and it will also highlight the use of combined approaches with new targeted agents. Other topics of interest to this Special Issue will be the discovery and analysis of radioresponse biomarkers reported by different in vitro, in vivo, or clinical studies.

Dr. Luigi Minafra
Dr. Francesco Paolo Cammarata
Dr. Marco Calvaruso
Guest Editors

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