Hypoxia (oxygen deprivation) occurs in most solid malignancies, albeit with considerable heterogeneity. Hypoxia is associated with an aggressive cancer phenotype by promotion of genomic instability, evasion of anti-cancer therapies including radiotherapy and enhancement of metastatic risk. Therefore, hypoxia results in poor cancer outcomes. Targeting hypoxia to improve cancer outcomes is an attractive therapeutic strategy. Hypoxia-targeted dose painting escalates radiotherapy dose to hypoxic sub-volumes, as quantified and spatially mapped using hypoxia imaging. This therapeutic approach could overcome hypoxia-induced radioresistance and improve patient outcomes without the need for hypoxia-targeted drugs. This article will review the premise and underpinning evidence for personalized hypoxia-targeted dose painting. It will present data on relevant hypoxia imaging biomarkers, highlight the challenges and potential benefit of this approach and provide recommendations for future research priorities in this field. Personalized hypoxia-based radiotherapy de-escalation strategies will also be addressed.

缺氧（缺氧）发生在大多数实体恶性肿瘤中，尽管具有相当大的异质性。缺氧通过促进基因组不稳定性、逃避包括放疗在内的抗癌治疗以及增加转移风险而与侵袭性癌症表型相关。因此，缺氧会导致癌症结果不佳。针对缺氧来改善癌症结果是一种有吸引力的治疗策略。缺氧目标剂量绘制将放射治疗剂量升级到缺氧子体积，使用缺氧成像进行量化和空间映射。这种治疗方法可以克服缺氧引起的放射抗性并改善患者的治疗结果，而无需针对缺氧进行治疗药物。本文将回顾个性化缺氧目标剂量绘制的前提和基础证据。它将提供相关缺氧成像生物标志物的数据，强调这种方法的挑战和潜在好处，并为该领域未来的研究重点提供建议。还将讨论基于缺氧的个性化放疗降级策略。