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Review
. 2014 Mar;53(1):1-29.
doi: 10.1007/s00411-013-0497-2. Epub 2013 Oct 20.

Current concepts in clinical radiation oncology

Michael Orth  1 , Kirsten Lauber, Maximilian Niyazi, Anna A Friedl, Minglun Li, Cornelius Maihöfer, Lars Schüttrumpf, Anne Ernst, Olivier M Niemöller, Claus Belka
Affiliations
Review

Current concepts in clinical radiation oncology

Michael Orth et al. Radiat Environ Biophys. 2014 Mar.

Abstract

Based on its potent capacity to induce tumor cell death and to abrogate clonogenic survival, radiotherapy is a key part of multimodal cancer treatment approaches. Numerous clinical trials have documented the clear correlation between improved local control and increased overall survival. However, despite all progress, the efficacy of radiation-based treatment approaches is still limited by different technological, biological, and clinical constraints. In principle, the following major issues can be distinguished: (1) The intrinsic radiation resistance of several tumors is higher than that of the surrounding normal tissue, (2) the true patho-anatomical borders of tumors or areas at risk are not perfectly identifiable, (3) the treatment volume cannot be adjusted properly during a given treatment series, and (4) the individual heterogeneity in terms of tumor and normal tissue responses toward irradiation is immense. At present, research efforts in radiation oncology follow three major tracks, in order to address these limitations: (1) implementation of molecularly targeted agents and 'omics'-based screening and stratification procedures, (2) improvement of treatment planning, imaging, and accuracy of dose application, and (3) clinical implementation of other types of radiation, including protons and heavy ions. Several of these strategies have already revealed promising improvements with regard to clinical outcome. Nevertheless, many open questions remain with individualization of treatment approaches being a key problem. In the present review, the current status of radiation-based cancer treatment with particular focus on novel aspects and developments that will influence the field of radiation oncology in the near future is summarized and discussed.

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Figures

Fig. 1
Fig. 1
Improvements in clinical radiotherapy with decisive impact in recent years
Fig. 2
Fig. 2
Mechanisms of cell death triggered by ionizing radiation
Fig. 3
Fig. 3
Survey of valuable targets for combined modality approaches
See this image and copyright information in PMC

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