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In this study, we assessed whether circulating tumor cell (CTC) enumeration, kinetics, and CTC viability (i.e., the apoptotic rate) could provide a more accurate tool for monitoring and stratifying the RT response. We analyzed CTCs and tumor\u2010derived extracellular vesicles (tdEVs) during RT in 71 lung (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200935) and breast (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200936) cancer patients receiving RT treatment for brain (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200954) and bone (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200919) metastases. The DNA repair capacity of the host was assessed by\n                    <jats:italic>ex vivo<\/jats:italic>\n                    irradiation of peripheral blood mononuclear cells (PBMCs). RT treatment did not seem, in most cases, to cause a short\u2010term release of CTCs. We found that both the number and apoptotic rate of CTCs before and after RT treatment is a powerful indicator of poor prognosis. Additionally, the fraction of apoptotic CTCs correlated with RT response and patient outcome. This study demonstrated that the RT response is associated with tumor\u2010specific traits, which can be accessed via easily accessible liquid biopsy approaches.\n                  <\/jats:p>","DOI":"10.1002\/1878-0261.70261","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T10:32:59Z","timestamp":1777026779000},"page":"2040-2053","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Circulating tumor cell viability during and after radiotherapy mirrors treatment response in cancer patients"],"prefix":"10.1002","volume":"20","author":[{"given":"Yvonne","family":"Goy","sequence":"first","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology University Medical Center Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jana","family":"L\u00f6ptien","sequence":"additional","affiliation":[{"name":"Department of Tumor 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