Microbiome and radiotherapy represent bidirectionally interacting entities. The human microbiome has emerged as a pivotal modulator of the efficacy and toxicity of radiotherapy; however, a reciprocal effect of radiotherapy on microbiome composition alterations has also been observed. This review explores the relationship between the microbiome and extracranial solid tumors, particularly focusing on the bidirectional impact of radiotherapy on organ-specific microbiome. This article aims to provide a systematic review on the radiotherapy-induced microbial alteration in-field as well as in distant microbiomes. In this review, particular focus is directed to the oral and gut microbiome, its role in the development and progression of cancer, and how it is altered throughout radiotherapy. This review concludes with recommendations for future research, such as exploring microbiome modification to optimize radiotherapy-induced toxicities or enhance its anti-cancer effects.

Charles University 3rd Faculty of Medicine Department of Oncology Prague Czech Republic

Czech University of Life Sciences Prague Department of Microbiology Nutrition and Dietetics Faculty of Agrobiology Food and Natural Resources Prague Czech Republic

Department of Oncology University Hospital Kralovske Vinohrady Prague Czech Republic

Department of Oncology University Hospital Kralovske Vinohrady Prague Czech Republic;

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