Dose- and time-resolved immune states in cervical cancer radiotherapy: dynamic multimodal biomarkers for adaptive immunoradiotherapy
- 1Department of Radiation Oncology, Ganzhou Cancer Hospital
- 2Department of Pathology, Ganzhou Cancer Hospital
Abstract
Concurrent and maintenance immune checkpoint blockade improves survival for select high-risk locally advanced cervical cancer patients treated with definitive chemoradiotherapy, yet population-level efficacy cannot identify responders, optimal timing of benefit, or actionable biological targets for resistance. Fractionated pelvic radiotherapy induces dynamic immune perturbation: antigen release and interferon signaling occur alongside lymphocyte depletion, impaired antigen presentation, suppressive myeloid remodeling and resistant tumor clone selection. Pretreatment biomarkers fail to capture this evolving biological landscape. This review synthesizes evidence for dose- and time-resolved tissue/blood immunity, longitudinal MRI/PET imaging, delta radiomics, multimodal artificial intelligence, and HPV circulating tumor DNA. Two key conclusions are drawn. First, serial studies show heterogeneous immune remodeling modulated by radiation dose, sampling site, assay platform and time point. Second, mid-treatment tumor regression has reproducible prognostic evidence, and post-treatment viral circulating tumor DNA has prospective validation for residual-risk assessment and monitoring. We categorize biomarker functions as response assessment, prognosis, treatment-effect prediction and monitoring, define six evidence gates, and propose trial-restricted decision windows to guide future translational investigations.
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BibTeX
@article{xiao2026dose,
title = {{Dose- and time-resolved immune states in cervical cancer radiotherapy: dynamic multimodal biomarkers for adaptive immunoradiotherapy}},
author = {Chengjian Xiao and Feilong Tian and Minli Kang and Fangping Xie},
journal = {Frontiers in Immunology},
year = {2026},
month = oct,
doi = {10.3389/fimmu.2026.1981103},
url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1981103/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Dose- and time-resolved immune states in cervical cancer radiotherapy: dynamic multimodal biomarkers for adaptive immunoradiotherapy
AU - Chengjian Xiao
AU - Feilong Tian
AU - Minli Kang
AU - Fangping Xie
PY - 2026
DA - 2026/10/22
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.1981103
UR - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1981103/full
AB - Concurrent and maintenance immune checkpoint blockade improves survival for select high-risk locally advanced cervical cancer patients treated with definitive chemoradiotherapy, yet population-level efficacy cannot identify responders, optimal timing of benefit, or actionable biological targets for resistance. Fractionated pelvic radiotherapy induces dynamic immune perturbation: antigen release and interferon signaling occur alongside lymphocyte depletion, impaired antigen presentation, suppressive myeloid remodeling and resistant tumor clone selection. Pretreatment biomarkers fail to capture this evolving biological landscape. This review synthesizes evidence for dose- and time-resolved tissue/blood immunity, longitudinal MRI/PET imaging, delta radiomics, multimodal artificial intelligence, and HPV circulating tumor DNA. Two key conclusions are drawn. First, serial studies show heterogeneous immune remodeling modulated by radiation dose, sampling site, assay platform and time point. Second, mid-treatment tumor regression has reproducible prognostic evidence, and post-treatment viral circulating tumor DNA has prospective validation for residual-risk assessment and monitoring. We categorize biomarker functions as response assessment, prognosis, treatment-effect prediction and monitoring, define six evidence gates, and propose trial-restricted decision windows to guide future translational investigations.
SN - 1664-3224
ER -