This thought-piece on the very essence of why we prescribe and deliver radiotherapy doses as we do is a must-read, particularly for the philosophy majors out there (anybody? anybody..?). The truth is, while we know what dose is required to control a certain tumor type for a majority of a population, we don’t know what dose is required to control any one person’s tumor. Conventional wisdom suggests we aspire to ever-increasing doses to tumor and ever-decreasing doses to everything else via increasing technological prowess (and financial and human resources). In reality, precision radiation is “singularly focused on the technical requirements of delivering doses that are quite unlikely to actually represent the optimal treatment for any particular patient.” After all, how many randomized trials have ever demonstrated a benefit of dose-escalation outside prostate cancer? Hint: not many. The hard truth is 10 Gy here or there just doesn’t matter as much as we think across a wide population of tumors that could each have many-fold different “curative” (i.e. non-replicative) thresholds. By the way, the same goes for any individual normal tissue complication. Most important to consider: “Radiation approaches that overemphasize anatomic accuracy in dose delivery, thus, enshrine current practices in a sense of false certainty while threatening to crowd out potentially more creative, efficacious, and cost-effective approaches to improving outcomes in patients treated with radiation.” | Ellsworth & Wilke, CURiE 2025