Precision Radiotherapy and Radiation Risk Assessment: How Do We Overcome Radiogenomic Diversity?

Review

Precision Radiotherapy and Radiation Risk Assessment: How Do We Overcome Radiogenomic Diversity?

HISANORI FUKUNAGA,¹ AKINARI YOKOYA,² YASUYUKI TAKI,³ KARL T. BUTTERWORTH¹ and KEVIN M. PRISE¹

¹Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK
²Tokai Quantum Beam Science Center, National Institutes for Quantum and Radiological Science and Technology, Tokai, Ibaraki, Japan
³Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan

Precision medicine is a rapidly developing area that aims to deliver targeted therapies based on individual patient characteristics. However, current radiation treatment is not yet personalized; consequently, there is a critical need for specific patient characteristics of both tumor and normal tissues to be fully incorporated into dose prescription. Furthermore, current risk assessment following environmental, occupational, or accidental exposures to radiation is based on population effects, and does not account for individual diversity underpinning radiosensitivity. The lack of personalized approaches in both radiotherapy and radiation risk assessment resulted in the current situation where a population-based model, effective dose, is being used. In this review article, to stimulate scientific discussion for precision medicine in both radiotherapy and radiation risk assessment, we propose a novel radiological concept and metric − the personalized dose and the personalized risk index − that incorporate individual physiological, lifestyle-related and genomic variations and radiosensitivity, outlining the potential clinical application for precision medicine. We also review on recent progress in both genomics and biobanking research, which is promising for providing novel insights into individual radiosensitivity, and for creating a novel conceptual framework of precision radiotherapy and radiation risk assessment.

keywords —— biobank; genomics; precision medicine; radiation risk; radiotherapy

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Tohoku J. Exp. Med., 2019, 247, 223-235

Correspondence: Hisanori Fukunaga, M.D., Centre for Cancer Research and Cell Biology, Queen's University Belfast, Northern Ireland BT9 7AE, UK.

e-mail: hfukunaga01@qub.ac.uk