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September 10, 2025

Narrative Review of the Use of Genomic-Adjusted Radiation Dose (GARD) in Radiotherapy.

Key Points

Genomic-adjusted radiation dose improves personalization of radiotherapy using tumor-specific data.
GARD integrates radiosensitivity index with linear quadratic model, showing effective results in several cancer types.
Retrospective studies confirm prognostic value of GARD since its introduction in 2017, paving the way for future trials.
New Phase II trials are validating GARD dosage in HPV-positive oropharyngeal cancer, focusing on tumor heterogeneity.

Abstract

This narrative review examines the genomic-adjusted radiation dose (GARD), a biologically informed framework developed to personalize radiotherapy by integrating tumor-specific genomic data. GARD combines the radiosensitivity index (RSI), based on gene expression, with the linear quadratic model to estimate patient-specific radiation effect. Since its introduction in 2017, GARD has demonstrated prognostic value across multiple cancer types in retrospective studies. This review summarizes key studies evaluating GARD across various tumor types and clinical contexts. Emerging trials, including a Phase II trial in HPV-positive oropharyngeal cancer, aim to validate GARD-guided dosing in precision radiotherapy. Future efforts may focus on refining RSI, addressing tumor heterogeneity, and validating GARD-guided dosing in prospective settings.

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