Radiation oncology has undergone a profound transformation over the past 50 years, evolving from broad techniques to highly conformal, precision-guided treatments. This review synthesizes key advancements in the field, first from technological innovations allowing the provision of precisely aligned and uniquely tailored radiation, customized to patient anatomy (such as intensity modulated radiation therapy, stereotactic body radiation therapy, and MR Linac) to emerging applications of particle beams, radiopharmaceuticals, and adaptive planning platforms. These advances have facilitated more accurate treatments and decreased side effect burden. The role of radiation therapy has also expanded in the management of metastatic disease beyond simply palliation, with ablative techniques leading to improved progression-free survival in oligometastatic settings. The combination of radiation with immunotherapy can introduce synergistic effects and is reshaping treatment paradigms across disease sites. However, widespread adoption of radiation innovation faces challenges, including rising financial toxicity, geographic disparities in access, and administrative burdens of previous authorization. As radiation oncology enters a new era, oncologists across specialties must remain informed about the evolving factors that affect timely radiation delivery.
Afzal et al. (2026) studied this question.