Understanding Biologically Guided Radiotherapy: Essential Insights for Surgical Oncologists

The technology in the radiotherapy field is approaching a new evolution day by day. The image-guided radiotherapy (IGRT) approach has changed the radiotherapy treatment workflow scenario. The image acquired before radiotherapy treatment helps minimize uncertainty in target positioning for accurate radiation delivery. Biologically guided radiotherapy (BgRT) is a new approach in radiotherapy through the IGRT modality to track the target with the help of radiopharmaceuticals. It acquires the image through PET-CT and attaches it to a linear accelerator before treatment to verify the target volume. BgRT, a pioneering technology, stands out with its unique ability to adapt dose delivery based on biological features, which sets it apart from conventional IGRT. By utilizing PET detection, BgRT can rapidly adjust the position of the linear accelerator to accommodate target motion, enabling precise dose delivery while sparing surrounding normal tissues. This represents a significant advancement, allowing for real-time tracking and adjusting radiation doses according to biological changes within the tumor. Additionally, a single tracer injection and a single treatment plan can effectively target multiple metastatic lesions, streamlining the treatment process. However, due to radioactive tracer uptake, BgRT is more suitable for hypo-fractionated or stereotactic treatments than conventional fractionation. This article provides an overview of the technological advancements of BgRT and their clinical implications in modern radiation oncology.