Radiation-Induced Esophagitis: From Clinical Observation to Precision Management

For the past seven decades, radiation-induced esophagitis (RE) has been a major dose-limiting acute toxicity of thoracic radiotherapy, substantially impairing patients' quality of life and their ability to complete planned treatment courses. Research on RE has progressed from phenomenological reporting to multidimensional quantification and, more recently, toward precision-driven intervention. This review provides a comprehensive overview of current research on the epidemiology, pathophysiology, diagnosis, risk stratification, predictive modeling, prevention, and treatment of radiation-induced esophagitis. Dose-volume parameters established an important quantitative framework for risk assessment, while more recent advances in genomic profiling, functional imaging, and artificial intelligence have supported the development of integrative multi-omics predictive models. Pharmacological prophylaxis has shown limited success in randomized trials, whereas technical refinements in radiation delivery and emerging regenerative approaches offer promising alternatives. Persistent knowledge gaps remain, including the need for prospective multicenter validation of omics-derived models, re-evaluation of RE risk in the immunotherapy era, investigation of chronomodulated treatment scheduling, and translation of tissue-engineering strategies into clinical practice. The review is intended to provide clinicians and investigators with a comprehensive reference and to support future research in thoracic radiation oncology.