# Dose painting and biologically guided radiotherapy

Source: https://onco.cc/technologies/dose-painting/  
OnCo record `dose-painting` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Instead of one uniform dose, the plan gives more to the parts of the tumour that imaging says are most resistant, such as hypoxic or highly active regions on PET.

## Summary

Functional imaging (FDG PET, hypoxia PET, diffusion and perfusion MRI) shows that tumours are not uniform. Dose painting escalates the dose to the imaging-defined resistant subvolume while holding the rest at standard levels, either by contours or voxel by voxel. Trials in head and neck cancer and glioblastoma have shown feasibility and some local-control signals; biology-guided radiotherapy systems that use PET emissions in real time to steer the beam (RefleXion) extend the idea to tracking. The limits are the reliability of the imaging signal and the risk of toxicity in the boosted region.

## Fields

- Kind: Technology
- Status: emerging
- Last checked: 2026-09-16
- Tags: radiation-wave1
- Principle: Imaging biomarkers define a resistant subvolume that receives a higher dose, matching dose to biology rather than to anatomy alone.
- Since: 2005
- Strengths: Targets the cells most likely to survive; Uses imaging already acquired; Real-time PET guidance emerging
- Limitations: Imaging signals are noisy and change over treatment; Clinical benefit not yet proven in phase 3; Higher local toxicity

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Dose_painting

## Connected records

- cancers: [Glioma & glioblastoma](https://onco.cc/cancers/glioblastoma/), [Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/)
- fronts: [Radiation Therapy](https://onco.cc/fronts/radiation/)
- technologies: [Adaptive radiotherapy (online replanning)](https://onco.cc/technologies/adaptive-radiotherapy/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [PET (positron emission tomography)](https://onco.cc/technologies/pet/)
- terms: [Tumour hypoxia](https://onco.cc/terms/tumour-hypoxia/)

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