Review: cutting-edge developments in radiotherapy: Advances in imaging, motion management and AI-driven treatment optimization

Radiotherapy has long been a cornerstone in cancer treatment, utilizing ionizing radiation to target and destroy malignant cells. Recent technological and biological advancements have significantly enhanced treatment precision, reduced radiation exposure to healthy tissues, and improved patient outcomes. This review explores key innovations in radiotherapy, focusing on imaging advancements, motion management techniques, and artificial intelligence (AI)-driven treatment optimization. MRI-guided radiotherapy (MRgRT) has revolutionized tumor visualization, allowing real-time adaptation to anatomical changes, improving hypofractionation treatments, and enhancing therapeutic effectiveness. However, challenges such as magnetic field interference, extended planning times, and MRI contrast variability necessitate further research. Additionally, PET-CT and functional imaging have improved tumor delineation, optimized radiation dose distribution, and facilitated adaptive radiotherapy planning, particularly in lymphomas and rectal cancer treatment. AI has emerged as a transformative tool in radiotherapy, offering innovative solutions for motion tracking, tumor monitoring, and real-time treatment adaptation. AI-driven motion management strategies, including markerless tracking, full anatomy monitoring, and predictive modeling, enhance treatment precision by compensating for organ and tumor motion, reducing dose uncertainties, and improving radiation targeting. Surface Guided Radiation Therapy (SGRT) has further contributed to improving patient positioning, continuous motion monitoring, and adaptive treatment strategies. Its application in proton therapy, pediatric oncology, and accelerated partial breast irradiation (APBI) highlights its versatility in modern radiotherapy. Future research should focus on refining SGRT methodologies, integrating advanced surface mapping technologies, and expanding its role in adaptive radiotherapy planning. As radiotherapy continues to evolve, integrating cutting-edge imaging, AI-based tracking, and adaptive treatment approaches will be crucial in optimizing cancer treatment. While challenges remain, ongoing interdisciplinary collaborations will drive further innovations, ultimately improving survival rates and quality of life for cancer patients.