It is well recognized that substantial heterogeneity of radiation response in normal tissues and tumors exists between individual patients as well as between individual tumors of the same histology. Even within a single tumor, different regions can have different radiosensitivities, dependent on, for example, tumor microenvironment, inhomogeneous distribution of cancer stem cells, or possibly specific genetic or molecular alterations. To really implement biology-driven precision radiation oncology, which tailors treatment to individual patients based on the biological features of the tumor or normal tissues beyond anatomical information, noninvasive biomarkers are essential. Clearly, repeated imaging that enables the presence and magnitude of specific mechanisms of radioresistance to be assessed in individual tumors would be extremely valuable. This chapter reviews the current clinical evidence on magnetic resonance imaging for response prediction and assessment.
KeywordsPrecision medicine Diffusion-weighted MRI Dynamic contrast-enhanced MRI
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