Individual radiosensitivity testing in 2025: Current advances and future directions for personalized radiotherapy

Area of Science:

• Oncology
• Radiation Biology
• Biomarker Discovery

Background:

• Personalized radiation oncology relies on predicting individual radiosensitivity (RS).
• Clinical implementation is hindered by biomarker variability and lack of consensus.
• This review examines recent progress in RS prediction and its clinical relevance.

Purpose of the Study:

• To synthesize advancements in radiosensitivity prediction.
• To evaluate the translational potential and clinical applicability of various biomarkers.
• To critically assess the validation status and limitations of current RS prediction approaches.

Main Methods:

• A narrative review of literature from 1980-2025 was performed.
• Searches included PubMed/MEDLINE and radiobiology journals.
• Key themes analyzed were genetic markers, functional assays, senescence biomarkers, and omics technologies.

Main Results:

• The Radiation-Induced Lymphocyte Apoptosis (RILA) assay strongly correlates with late toxicity (AUC=0.72 for breast fibrosis).
• Fibroblast assays (SF2, ATM translocation) offer tissue-specific predictions.
• Senescence markers and omics signatures provide mechanistic insights but need standardization.

Conclusions:

• Radiosensitivity prediction is moving towards clinical utility, with RILA as the leading validated assay.
• Future work requires multicenter validation, cost-effective omics, and biomarker-guided adaptive trials.
• Optimizing therapeutic ratios in radiation oncology is the ultimate goal.