Why So Challenging to Personalize Radiation Dose?

The primary treatment tool for radiation oncologists is of course, radiation. After many decades of clinical application, one would think the optimal radiation dose and fractionation for virtually every cancer would be beautifully defined according to clinical data for each tumor type. Not so in fact. For the majority of human cancers, radiation doses routinely prescribed in clinical practice largely reflect adjacent normal tissue tolerance and perceived patient safety (1, 2). We routinely limit radiation dose to bowel, brain, heart, lung, kidney, spinal cord, and many other normal organs according to the severity of clinical consequences from exceeding normal tissue tolerance.

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