Dose- and time-resolved immune states in cervical cancer radiotherapy: dynamic multimodal biomarkers for adaptive immunoradiotherapy.
Authors
Affiliations (2)
Affiliations (2)
- Department of Radiation Oncology, Ganzhou Cancer Hospital, Ganzhou, China.
- Department of Pathology, Ganzhou Cancer Hospital, Ganzhou, China.
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.