Preclinical lung studies support normal-tissue sparing, but uncertain biological thresholds, dose conformity, and respiratory motion still prevent clinical implementation.
Positive margins more than doubled mortality risk and quadrupled local recurrence risk in a meta-analysis of 2,438 post-radiation sarcoma patients.
None of four selected blood-biomarker domains currently supports treatment personalization, and sampling schedules frequently failed to match expected biological kinetics.
Twelve trials used 14 immunotherapy regimens with major differences in eligibility, radiotherapy, chemotherapy, endpoints, and translational analysis.
Randomized evidence suggested a 4.5-point increase in second-cancer incidence, while excess mortality from other cancers was substantially smaller.
MRI-defined biopsy-confirmed lesions can be boosted safely when robust image guidance and normal-tissue constraints take priority over complete boost coverage.
Successful breast brachytherapy depends on careful patient selection, suitable cavity anatomy, sound implant geometry, accurate reconstruction, and rigorous treatment QA.
Robust photon planning usually improved uncertainty-resistant target coverage, but modelling, evaluation, and reporting varied substantially across the literature.
No individual clinical, imaging, blood, or molecular marker reliably predicted pathological complete response, while integrated multimodal models showed greater potential.
SBRT provided competitive peripheral coverage in some plans but could not consistently reproduce brachytherapy’s central dose escalation after realistic margins were applied.
EQD2 should remain the reporting standard, but delivery time, dose gradients, biological assumptions and dose accumulation materially affect its interpretation.
IPEM, AAPM and NCS recommendations largely aligned, with complementary guidance for MRI simulation, MR-only workflows and MR-Linac quality assurance.
Response-guided target reduction has the strongest evidence, while proton therapy and immunotherapy-based de-escalation remain less established.
Response-guided target reduction and sequential chemoradiotherapy have the strongest evidence, while proton and immunotherapy-based approaches remain less established.
Chemotherapy and radiotherapy resistance may converge on shared DNA-repair, redox, metabolic, stemness and microenvironmental adaptations.