Histopathology and clinical staging have historically formed the backbone for allocation of treatment decisions in oncology. Although this has provided an extremely practical and fruitful approach for decades, it has long been evident that these data alone do not adequately capture the heterogeneity and breadth of disease trajectories experienced by patients. As efficient and affordable DNA and RNA sequencing have become available, the ability to provide precision therapy has become within grasp. This has been realized with systemic oncologic therapy, as targeted therapies have demonstrated immense promise for subsets of patients with oncogene-driver mutations. Further, several studies have evaluated predictive biomarkers for response to systemic therapy within a variety of malignancies. Within radiation oncology, the use of genomics/transcriptomics to guide the use, dose, and fractionation of radiation therapy is rapidly evolving but still in its infancy. The genomic adjusted radiation dose/radiation sensitivity index is one such early and exciting effort to provide genomically guided radiation dosing with a pan-cancer approach. In addition to this broad method, a histology specific approach to precision radiation therapy is also underway. Herein we review select literature surrounding the use of histology specific, molecular biomarkers to allow for precision radiotherapy with the greatest emphasis on commercially available and prospectively validated biomarkers.

组织病理学和临床分期历来构成了肿瘤学治疗决策分配的支柱。尽管几十年来这提供了一种极其实用且富有成效的方法，但长期以来很明显，这些数据本身并不能充分捕捉患者经历的疾病轨迹的异质性和广度。高效且经济实惠的 DNA 和 RNA 测序随着这些技术的出现，提供精准治疗的能力已变得触手可及。这已经通过全身肿瘤治疗实现，因为靶向治疗已经证明对具有癌基因驱动突变的患者亚群具有巨大的前景。此外，一些研究评估了多种恶性肿瘤对全身治疗反应的预测生物标志物。在放射肿瘤学中，使用基因组学/转录组学来指导放射肿瘤学的使用、剂量和分割放射治疗正在迅速发展，但仍处于起步阶段。基因组调整辐射剂量/辐射敏感性指数是一项早期且令人兴奋的努力，旨在通过泛癌方法提供基因组引导的辐射剂量。除了这种广泛的方法之外，一种针对精确放射治疗的组织学特定方法也在进行中。在此，我们回顾了有关使用组织学特异性分子生物标志物进行精准放射治疗的精选文献，其中最强调商业上可用的和前瞻性验证的生物标志物。