Surgery, radiotherapy (RT), and brachytherapy are crucial
treatments
for localized deep tumors. However, imprecise tumor location often
leads to issues such as positive surgical margins, extended radiotherapy
target volumes, and radiation damage to healthy tissues. Reducing
side effects in healthy tissue and enhancing RT efficacy are critical
challenges. To address these issues, we developed a multifunctional
theranostic platform using Au/Ag nanodots (Au/AgNDs) that act as a
“pilot light” for real-time guided surgery, high-efficiency
RT, and brachytherapy, achieving a strategy of killing three birds
with one stone. First, dual-mode imaging of Au/AgNDs enabled precision
RT, minimizing damage to adjacent normal tissue during X-ray irradiation.
Au/AgNDs enhanced ionizing radiation energy deposition, increased
intracellular reactive oxygen species (ROS) generation, regulated
the cell cycle, promoted DNA damage formation, and inhibited DNA repair
in tumor cells, significantly improving RT efficacy. Second, in brachytherapy,
precise guidance provided by dual-mode imaging addressed challenges
related to non-visualization of existing interstitial brachytherapy
and multiple adjustments of insertion needle positions. Meanwhile,
the effect of brachytherapy was improved. Third, the excellent fluorescence
imaging of Au/AgNDs accurately distinguished tumors from normal tissue,
facilitating their use as a powerful tool for assisting surgeons during
tumor resection. Taken together, our multifunctional theranostic platform
offers real-time guidance for surgery and high-efficiency RT, and
improves brachytherapy precision, providing a novel strategy and vision
for the clinical diagnosis and treatment of cancer.