The genomic era has significantly changed the practice of clinical oncology. The use of genomic-based molecular diagnostics including prognostic genomic signatures and new-generation sequencing has become routine for clinical decisions regarding cytotoxic chemotherapy, targeted agents and immunotherapy. In contrast, clinical decisions regarding radiation therapy (RT) remain uninformed about the genomic heterogeneity of tumors. In this review, we discuss the clinical opportunity to utilize genomics to optimize RT dose. Although from the technical perspective, RT has been moving towards a data-driven approach, RT prescription dose is still based on a one-size-fits all approach, with most RT dose based on cancer diagnosis and stage. This approach is in direct conflict with the realization that tumors are biologically heterogeneous, and that cancer is not a single disease. Here, we discuss how genomics can be integrated into RT prescription dose, the clinical potential for this approach and how genomic-optimization of RT dose could lead to new understanding of the clinical benefit of RT.

基因组时代极大地改变了临床肿瘤学的实践。基于基因组的分子诊断（包括预后基因组特征和新一代测序）的使用已成为有关细胞毒性化疗、靶向药物和免疫治疗的临床决策的常规方法。相反，有关的临床决策放射治疗（RT）仍然不了解肿瘤的基因组异质性。在这篇综述中，我们讨论了利用基因组学来优化放疗剂量的临床机会。尽管从技术角度来看，放疗已经朝着数据驱动的方向发展，但放疗处方剂量仍然基于一刀切的方法，大多数放疗剂量基于癌症的诊断和分期。这种方法与肿瘤具有生物学异质性以及癌症不是单一疾病的认识直接冲突。在这里，我们讨论如何将基因组学整合到 RT 处方剂量中、这种方法的临床潜力以及 RT 剂量的基因组优化如何导致对 RT 临床益处的新认识。