{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T09:16:58Z","timestamp":1788254218285,"version":"build-2803163510"},"reference-count":95,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Magnetic resonance-guided radiotherapy (MRgRT) delivered with MR-linac technology represents a major advance in lung cancer radiotherapy, enabling daily online adaptive planning based on high-quality soft-tissue visualization, real-time motion assessment, and anatomy-driven treatment personalization. The challenges in lung cancer treatment with conventional radiotherapy delivery due to respiratory motion, inter and intra-fraction anatomical changes make MRgRT capabilities particularly relevant. This narrative review provides an overview of the current state of the art of MR-guided adaptive radiotherapy in lung cancer, focusing on technical foundations, adaptive workflows, and clinical implementation across different disease stages. Key aspects as patient selection, adaptive decision-making, motion management strategies, and integration into routine clinical practice are discussed. Finally, emerging clinical applications and future directions\u2014including adaptive dose personalization and integration of functional imaging\u2014are outlined, highlighting the potential role of MR-linac\u2013based adaptive radiotherapy as a platform for precision radiotherapy in lung cancer.<\/jats:p>","DOI":"10.3390\/cancers18172819","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T08:31:13Z","timestamp":1788251473000},"page":"2819","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["MR-Guided Adaptive Radiotherapy in Lung Cancer: Current Landscape and Future Directions"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6494-8197","authenticated-orcid":false,"given":"Abrahams","family":"Ocanto","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, San Francisco de As\u00eds University Hospital, GenesisCare, 28002 Madrid, Spain"},{"name":"Department of Radiation Oncology, Vithas La Milagrosa University Hospital, GenesisCare, 28010 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1719-622X","authenticated-orcid":false,"given":"Macarena","family":"Teja","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Gregorio Mara\u00f1\u00f3n General University Hospital, 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7757-7653","authenticated-orcid":false,"given":"Daniela","family":"Gonsalves","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, San Francisco de As\u00eds University Hospital, GenesisCare, 28002 Madrid, Spain"},{"name":"Department of Radiation Oncology, Vithas La Milagrosa University Hospital, GenesisCare, 28010 Madrid, Spain"},{"name":"Department of Medicine, Faculty of Medicine, Health and Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter","family":"V\u00e1squez","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Jim\u00e9nez D\u00edaz University Hospital, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inmaculada","family":"Navarro-Domenech","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, La Paz University Hospital, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Moreno-Jimenez","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Cl\u00ednica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria","family":"Guardia","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, San Francisco de As\u00eds University Hospital, GenesisCare, 28002 Madrid, Spain"},{"name":"Department of Radiation Oncology, Vithas La Milagrosa University Hospital, GenesisCare, 28010 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dulce","family":"Urias","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, National Cancer Institute (INCAN), Mexico City 14080, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scarlet","family":"Crespo","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Santa Creu i Sant Pau Hospital, 08041 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana","family":"Temes","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, 12 de Octubre University Hospital, 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolly","family":"Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Cl\u00ednica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3995-2204","authenticated-orcid":false,"given":"Suresh","family":"Senan","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, 1117 Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Drew","family":"Moghanaki","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of California, Los Angeles, CA 90095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Morera","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, La Paz University Hospital, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignacio","family":"Azinovic","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Cl\u00ednica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Luna","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Jim\u00e9nez D\u00edaz University Hospital, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7233-0234","authenticated-orcid":false,"given":"Felipe","family":"Cou\u00f1ago","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, San Francisco de As\u00eds University Hospital, GenesisCare, 28002 Madrid, Spain"},{"name":"Department of Radiation Oncology, Vithas La Milagrosa University Hospital, GenesisCare, 28010 Madrid, Spain"},{"name":"Department of Medicine, Faculty of Medicine, Health and Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"key":"ref_1","first-page":"e70090","article-title":"Global cancer statistics 2024: GLOBOCAN estimates of incidence and mortality worldwide for 34 cancers in 186 countries","volume":"76","author":"Sung","year":"2026","journal-title":"CA Cancer J. 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