Medical Oncology and Radiotherapy Department, University of Craiova,
Medical Physics Department, Regional Institute of Oncology,
In the last decades the technological advances in the field of radiotherapy and the implementation of the concepts of multimodal treatments in the therapeutic approach of cancer have changed the toxicity profile of the treatments. The implementation of image guided radiotherapy (IGRT) and the use of the intensity modulated irradiation technique led to a reduction of the doses received by the radiosensitive organs with expected results a reduction of the toxicity. The use of multimodale treatments including chemotherapy, molecular target therapy and immunotherapy often bring the benefit of the tumoricidal synergistic effect but also increase the risk of toxicity. Progress in identifying molecular, genetic or imaging markers of response to therapy has led to a refinement of radiobiological concepts regarding tumor radiosensitivity. Improving survival in metastatic disease in many locations has made it necessary to reassess the risk of late toxicity of old therapeutic protocols. In this context, the identification of dose-volume toxicity correlations and the choice between the clinical and therapeutic biological particularities of optimal radiotherapy schemes regarding the benefit-toxicity ratio becomes desirable. From the radiobiological point of view: reactivation of anti-tumor immune response is considered the 6th R of radiobiology with significant therapeutic implications. Creating multivariable radiobiological models that can be used in clinical routine is also a priority of translational research in radiobiology and radiation oncology.