手术、放射治疗 (RT) 和近距离放射治疗是局部深部肿瘤的重要治疗方法。然而，不精确的肿瘤定位往往会导致诸如手术切缘阳性、放疗靶区扩大以及对健康组织的放射损伤等问题。减少健康组织的副作用和提高放疗疗效是关键的挑战。为了解决这些问题，我们开发了一个多功能治疗诊断平台，使用金/银纳米点（Au/AgND）作为实时引导手术、高效放疗和近距离放射治疗的“指示灯”，实现了杀死三名患者的策略鸟与一石。首先，Au/AgND 的双模式成像实现了精确 RT，最大限度地减少了 X 射线照射期间对邻近正常组织的损伤。 Au/AgNDs增强电离辐射能量沉积，增加细胞内活性氧（ROS）生成，调节细胞周期，促进DNA损伤形成，抑制肿瘤细胞DNA修复，显着提高RT疗效。其次，在近距离放射治疗中，双模式成像提供的精确指导解决了与现有间质近距离放射治疗的非可视化和插入针位置的多次调整相关的挑战。同时，近距离放射治疗的效果也得到了改善。第三，Au/AgND 出色的荧光成像可以准确地区分肿瘤与正常组织，使其成为协助外科医生切除肿瘤的有力工具。总而言之，我们的多功能治疗诊断平台为手术和高效放疗提供实时指导，并提高近距离放射治疗精度，为癌症的临床诊断和治疗提供了新颖的策略和愿景。© 2023 作者。由美国化学会出版。

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.© 2023 The Authors. Published by American Chemical Society.