Owing to advances in radiotherapy, the physical properties of radiation can be optimized to enable individualized treatment; however, optimization is rarely based on biological properties and, therefore, treatments are generally planned with the assumption that all tumours respond similarly to radiation. Radiation affects multiple cellular pathways, including DNA damage, hypoxia, proliferation, stem cell phenotype and immune response. In this Review, we summarize the effect of these pathways on tumour responses to radiotherapy and the current state of research on genomic classifiers designed to exploit these variations to inform treatment decisions. We also discuss whether advances in genomics have generated evidence that could be practice changing and whether advances in genomics are now ready to be used to guide the delivery of radiotherapy alone or in combination.

由于放射治疗的进步，可以优化辐射的物理特性以实现个体化治疗；然而，优化很少基于生物学特性，因此，通常在假设所有肿瘤对辐射的反应相似的情况下规划治疗。辐射影响多种细胞通路，包括 DNA 损伤、缺氧、增殖、干细胞表型和免疫反应。在这篇综述中，我们总结了这些途径对肿瘤对放疗反应的影响，以及旨在利用这些变异为治疗决策提供信息的基因组分类器的研究现状。