Radiomics, which integrates the comprehensive characterization of imaging phenotypes with machine learning algorithms, is increasingly recognized for its potential in the diagnosis and prognosis of oncological conditions. However, the repeatability and reproducibility of radiomic features are critical challenges that hinder their widespread clinical adoption. This review aims to address the paucity of discussion regarding the factors that influence the reproducibility and repeatability of radiomic features and their subsequent impact on the application of radiomic models. We provide a synthesis of the literature on the repeatability and reproducibility of CT/MR-based radiomic features, examining sources of variation, the number of reproducible features, and the availability of individual feature repeatability indices. We differentiate sources of variation into random effects, which are challenging to control but can be quantified through simulation methods such as perturbation, and biases, which arise from scanner variability and inter-reader differences and can significantly affect the generalizability of radiomic model performance in diverse settings. Four suggestions for repeatability and reproducibility studies are suggested: (1) detailed reporting of variation sources, (2) transparent disclosure of calculation parameters, (3) careful selection of suitable reliability indices, and (4) comprehensive reporting of reliability metrics. This review underscores the importance of random effects in feature selection and harmonizing biases between development and clinical application settings to facilitate the successful translation of radiomic models from research to clinical practice.

Despite advances in head and neck cancer treatment, virtually all patients experience chemoradiation-induced toxicities. Oral mucositis (OM) and dysphagia are among the most prevalent and have a systemic impact on patients, hampering treatment outcome and harming quality of life. Accurate prediction of severe cases is crucial for improving management strategies and, ultimately, patient outcomes. This scoping review comprehensively maps the reported predictors and critically evaluates the performance, methodology, and reporting of predictive models for these conditions. A total of 174 studies were identified from database searches, with 73 reporting OM predictors, 97 reporting dysphagia predictors, and 4 reporting both OM and dysphagia predictors. These predictors included patient demographics, tumor classification, chemoradiotherapy regimen, radiation dose to organs-at-risk, genetic factors, and results of clinical laboratory tests. Notably, many studies only conducted univariate analysis or focused exclusively on certain predictor types. Among the included studies, numerous predictive models were reported: eight for acute OM, five for acute dysphagia, and nine for late dysphagia. The area under the receiver operating characteristic curve (AUC) ranged between 0.65 and 0.81, 0.60 and 0.82, and 0.70 and 0.85 for acute oral mucositis, acute dysphagia, and late dysphagia predictive models, respectively. Several areas for improvement were identified, including the need for external validation with sufficiently large sample sizes, further standardization of predictor and outcome definitions, and more comprehensive reporting to facilitate reproducibility.

Advancements in radiotherapy (RT) techniques such as intensity modulation, image guidance, and hypofractionation have facilitated a satisfactory survival outcome in prostate cancer (PCa) patients. However, virtually all PCa patients suffer from various types and extents of radiation toxicities, which are mainly gastrointestinal (GI) and genitourinary (GU) in nature, eroding their quality of life. Thus, early mitigation and preventative measures should be offered, enabled by accurate toxicity prediction. This scoping review provides a comprehensive summary of reported acute and late GI and GU toxicity predictors of conventional fractionation (CFRT), moderate hypofractionation (MHRT), and ultra-hypofractionation (UHRT). A total of 169 studies published between the years 2000 and 2024 (inclusive) were identified from four databases, with 127 and 78 studies investigating GI and GU toxicities, respectively. Univariate analysis was employed in 139 studies to identify predictors, while 94 studies involved multivariate analysis, 40 involved internal model validation, and 5 performed external model validation. Among all studies, dosimetric predictors are the most reported factors, followed by patient, clinical, treatment, disease, genetic, and radiomic features. However, their applicability and performance have not yet been extensively proven in external validation involving multicenter studies. Future predictive studies should also focus on deeper multimodality information, such as radiomics, in addition to the categories of factors consolidated in this study, for an all-rounded investigation. A multicenter study is highly encouraged for prospective external validation. Further investigations into delivered doses and sub-volumes of various regions of interest are necessary. Comprehensive reporting items suggested in this work shall facilitate the reproducibility and comparability of the results.

Purpose: Oral mucositis (OM) is one of the most prevalent and crippling treatment-related toxicities experienced by nasopharyngeal carcinoma (NPC) patients receiving radiotherapy (RT), posing a tremendous adverse impact on quality of life. This multi-center study aimed to develop and externally validate a multi-omic prediction model for severe OM. Methods: Four hundred and sixty-four histologically confirmed NPC patients were retrospectively recruited from two public hospitals in Hong Kong. Model development was conducted on one institution (n = 363), and the other was reserved for external validation (n = 101). Severe OM was defined as the occurrence of CTCAE grade 3 or higher OM during RT. Two predictive models were constructed: 1) conventional clinical and DVH features and 2) a multi-omic approach including clinical, radiomic and dosiomic features. Results: The multi-omic model, consisting of chemotherapy status and radiomic and dosiomic features, outperformed the conventional model in internal and external validation, achieving AUC scores of 0.67 [95% CI: (0.61, 0.73)] and 0.65 [95% CI: (0.53, 0.77)], respectively, compared to the conventional model with 0.63 [95% CI: (0.56, 0.69)] and 0.56 [95% CI: (0.44, 0.67)], respectively. In multivariate analysis, only the multi-omic model signature was significantly correlated with severe OM in external validation (p = 0.017), demonstrating the independent predictive value of the multi-omic approach. Conclusion: A multi-omic model with combined clinical, radiomic and dosiomic features achieved superior pre-treatment prediction of severe OM. Further exploration is warranted to facilitate improved clinical decision-making and enable more effective and personalized care for the prevention and management of OM in NPC patients.

Radiogenomics is a rapidly developing field that links radiological image features (radiomics) to genomic‐level data (genomics, transcriptomics, and epigenomics), addressing the limitations of single‐omic approaches. Radiomics provides a noninvasive and cost‐effective method to capture tissue‐level characteristics, while genomics elucidates the underlying molecular mechanisms. The central hypothesis is that the formation of imaging phenotypes is associated with the genetic and molecular processes, and thus can reflect underlying biological activities. This review presents the fundamental principles of radiogenomic analysis, covering key concepts in image analysis and gene analysis, as well as advanced analytical techniques for linking imaging and genomic data. Moreover, we summarize recent research findings across various human diseases, including oncology and nononcology, to highlight the current understandings and achievements in this field. Radiogenomics shows potential in clinical applications for elucidating disease mechanisms, detecting genomic variations noninvasively, and improving prognosis predictions. However, its implementation in clinical practice is limited by data scarcity, analytical methods, and barriers in translational processes. Future research should focus on enhancing data quality and establishing guidelines, developing analytical platforms, and validating current findings through animal models and clinical trials.

Background/Objectives: Existing literature reviews have not focused on the acute and late toxicities of non-magnetic resonance imaging (MRI)-guided adaptive radiation therapy (ART), compared the impacts of non-MRI-guided versus MRI-guided ART, or evaluated the effectiveness of adaptive conventional fractionated radiation therapy (CFRT) and stereotactic body radiation therapy (SBRT) in relation to toxicity in prostate cancer (PCa). The purpose of this scoping review was to systematically identify original articles and evaluate the impact of ART on toxicity in PCa in a comprehensive manner. Methods: A literature search was conducted using electronic databases on 17 June 2025, identifying 27 eligible papers. Results: The overall median toxicities of ART in PCa were 15.0% (acute grade 1 gastrointestinal (GI)), 1.0% (acute grade 2 GI), 0.0% (acute grade 3 GI), 47.1% (acute grade 1 genitourinary (GU)), 9.6% (acute grade 2 GU), 0.0% (acute grade 3 GU), 10.0% (late grade 1 GI), 2.0% (late grade 2 GI), 0.0% (late grade 3 GI), 29.7% (late grade 1 GU), 5.0% (late grade 2 GU), and 0.0% (late grade 3 GU). The choice of image guidance modality for ART does not appear to substantially influence toxicity; however, dedicated commercial ART systems may contribute to reducing toxicity to lower levels in PCa. Furthermore, the toxicity rates of adaptive CFRT and SBRT were comparable. Conclusions: Adaptive CFRT may be considered when SBRT is unsuitable for certain patients, without increasing the risk of side effects. However, further research is warranted to evaluate dedicated commercial cone-beam computed tomography (CT)- and CT-guided ART systems.