ABSTRACT
Radiotherapy targeting and delivery have improved over the last two decades due to advances in medical physics, planning software and imaging for staging and delineation of tumour extent. Radiotherapy is now targeted with increased accuracy to tumours while minimising doses to surrounding healthy tissue. This improved delivery reduces toxicity and is leading to treatment intensification with a move towards isotoxic dose-escalated radiotherapy. To further improve clinical outcome, precision radiotherapy includes the established use of concurrent chemotherapy. There are also a number of molecularly targeted agents to prescribe or investigate in combination with radiotherapy to improve tumour cell kill. Trials combining immunotherapy with (chemo)radiotherapy are also underway. Given the increased toxicity with multi-modality treatment, there is an increasing need to identify patients who are likely to benefit from these more aggressive (intensified) treatments using relevant biomarkers and spare those who are unlikely to benefit. Improvements with physical optimisation are now being realised and further gains in therapeutic ratio should be possible using biological optimisation.
