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Radiopharmaceutical-Guided Personalized Adjuvant Radiotherapy Planning after Esophageal Cancer Resection.

Zhida Fu¹, Yinghui Fang², Dapeng Wang³

¹Aviation General Hospital (Thoracic Surgery), Chaoyang, Beijing, China.

Cancer Biotherapy & Radiopharmaceuticals

|May 4, 2026

Summary

This summary is machine-generated.

Personalized adjuvant radiation therapy using radionuclide imaging improves esophageal cancer treatment by increasing tumor control and reducing side effects. This precision approach enhances outcomes after surgery.

Keywords:

biological dose painting esophageal cancer normal tissue complication probability radiopharmaceutical-guided radiotherapy tumor control probability voxel-based dosimetric optimization

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Area of Science:

Oncology
Radiotherapy
Molecular Imaging

Background:

Esophageal cancer resection carries a high risk of locoregional recurrence.
Conventional radiation therapy may fail to detect microscopic disease or tumor heterogeneity.
Anatomical imaging limits precision in postoperative radiation planning.

Purpose of the Study:

To evaluate the feasibility and efficacy of radionuclide-informed individualized adjuvant radiation planning.
To assess the role of molecular imaging in adaptive radiation dosage adjustment.
To improve precision in postoperative management of esophageal cancer.

Main Methods:

Utilized Positron Emission Tomography (PET)/Computed Tomography (CT) with tumor-specific tracers for molecular imaging.
Employed voxel-based dose painting for personalized radiation planning.
Compared treatment plans using conformity index, homogeneity index, V95% coverage, tumor control probability (TCP), and normal tissue complication probability (NTCP).

Main Results:

Radiopharmaceutical imaging identified additional high-risk areas in 34.7% of patients.
Personalized planning significantly improved conformity index, V95% coverage, and TCP.
Mean lung and heart doses decreased, reducing predicted NTCP for pneumonitis from 16.5% to 9.2% (p < 0.001).

Conclusions:

Radionuclide-guided personalized adjuvant radiation enhances biological target coverage and tumor control probability.
This approach effectively minimizes normal tissue toxicity in esophageal cancer patients.
Precision postoperative management using molecular imaging is crucial for improving patient outcomes.