Sun R, Sbai A, Ganem G, Boudabous M, Collin F, Marcy P-Y, Doglio A, Thariat J
Département de radiothérapie, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
Centre régional d'oncologie Hassan-II, BP 2013, Oued Nachef, Oujda, Maroc.
Cancer Radiother. 2014 Dec;18(8):770-8. doi: 10.1016/j.canrad.2014.08.004. Epub 2014 Oct 14.
Radiotherapy is advocated in the treatment of cancer of over 50 % of patients. It has long been considered as a focal treatment only. However, the observation of effects, such as fatigue and lymphopenia, suggests that systemic effects may also occur. The description of bystander and abscopal effects suggests that irradiated cells may exert an action on nearby or distant unirradiated cells, respectively. A third type of effect that involves feedback interactions between irradiated cells was more recently described (cohort effect). This new field of radiation therapy is yet poorly understood and the definitions suffer from a lack of reproducibility in part due to the variety of experimental models. The bystander effect might induce genomic instability in non-irradiated cells and is thus extensively studied for a potential risk of radiation-induced cancer. From a therapeutic perspective, reproducing an abscopal effect by using a synergy between ionizing radiation and immunomodulatory agents to elicit or boost anticancer immune responses is an interesting area of research. Many applications are being developed in particular in the field of hypofractionated stereotactic irradiation of metastatic disease.
超过50%的癌症患者在治疗中采用放疗。长期以来，放疗一直仅被视为一种局部治疗方法。然而，对诸如疲劳和淋巴细胞减少等效应的观察表明，放疗也可能产生全身效应。对旁观者效应和远隔效应的描述表明，受照射细胞可能分别对附近或远处未受照射的细胞产生作用。最近还描述了第三种效应，即涉及受照射细胞之间反馈相互作用的效应（队列效应）。放射治疗的这个新领域尚未得到充分理解，部分由于实验模型的多样性，其定义缺乏可重复性。旁观者效应可能会在未受照射的细胞中诱发基因组不稳定，因此人们对其辐射诱发癌症的潜在风险进行了广泛研究。从治疗角度来看，通过利用电离辐射与免疫调节剂之间的协同作用来引发或增强抗癌免疫反应，从而重现远隔效应，是一个有趣的研究领域。目前正在开发许多应用，特别是在转移性疾病的低分割立体定向放射治疗领域。
