Institute of Pharmaceutical Research, GLA University, Mathura, 281406, U.P., India.
Medical Laboratories Techniques Department, Al-Mustaqbal University College, Babylon, Hilla, 51001, Iraq.
Curr Med Chem. 2024;31(42):6992-7014. doi: 10.2174/0109298673248404231006052436.
Although radiotherapy is one of the main cancer treatment modalities, exposing healthy organs/tissues to ionizing radiation during treatment and tumor resistance to ionizing radiation are the chief challenges of radiotherapy that can lead to different adverse effects. It was shown that the combined treatment of radiotherapy and natural bioactive compounds (such as silymarin/silibinin) can alleviate the ionizing radiation-induced adverse side effects and induce synergies between these therapeutic modalities. In the present review, the potential radiosensitization effects of silymarin/silibinin during cancer radiation exposure/radiotherapy were studied.
According to the PRISMA guideline, a systematic search was performed for the identification of relevant studies in different electronic databases of Google Scholar, PubMed, Web of Science, and Scopus up to October 2022. We screened 843 articles in accordance with a predefined set of inclusion and exclusion criteria. Seven studies were finally included in this systematic review.
Compared to the control group, the cell survival/proliferation of cancer cells treated with ionizing radiation was considerably less, and silymarin/silibinin administration synergistically increased ionizing radiation-induced cytotoxicity. Furthermore, there was a decrease in the tumor volume, weight, and growth of ionizing radiation-treated mice as compared to the untreated groups, and these diminutions were predominant in those treated with radiotherapy plus silymarin/ silibinin. Furthermore, the irradiation led to a set of biochemical and histopathological changes in tumoral cells/tissues, and the ionizing radiation-induced alterations were synergized following silymarin/silibinin administration (in most cases).
In most cases, silymarin/silibinin administration could sensitize the cancer cells to ionizing radiation through an increase of free radical formation, induction of DNA damage, increase of apoptosis, inhibition of angiogenesis and metastasis, etc. However, suggesting the use of silymarin/silibinin during radiotherapeutic treatment of cancer patients requires further clinical studies.
尽管放疗是癌症治疗的主要方法之一，但在治疗过程中使健康器官/组织暴露于电离辐射以及肿瘤对电离辐射的抵抗是放疗面临的主要挑战，这可能导致各种不良反应。研究表明，放疗联合天然生物活性化合物（如水飞蓟素/水飞蓟宾）的治疗可以减轻电离辐射引起的不良反应，并增强这些治疗方式之间的协同作用。在本综述中，研究了水飞蓟素/水飞蓟宾在癌症放射暴露/放疗过程中的潜在放射增敏作用。
根据 PRISMA 指南，在 Google Scholar、PubMed、Web of Science 和 Scopus 等不同电子数据库中进行了系统检索，以确定截至 2022 年 10 月的相关研究。我们按照预先设定的纳入和排除标准筛选了 843 篇文章。最终有 7 项研究纳入本系统综述。
与对照组相比，经电离辐射处理的癌细胞的细胞存活/增殖明显减少，而水飞蓟素/水飞蓟宾的给药则协同增加了电离辐射诱导的细胞毒性。此外，与未治疗组相比，接受电离辐射治疗的小鼠的肿瘤体积、重量和生长均减少，而联合使用放疗加用水飞蓟素/水飞蓟宾的小鼠减少更为显著。此外，照射导致肿瘤细胞/组织发生一系列生化和组织病理学变化，而水飞蓟素/水飞蓟宾给药协同增强了电离辐射诱导的改变（在大多数情况下）。
在大多数情况下，水飞蓟素/水飞蓟宾给药可通过增加自由基形成、诱导 DNA 损伤、增加细胞凋亡、抑制血管生成和转移等来增加癌细胞对电离辐射的敏感性。然而，建议在癌症患者的放射治疗中使用水飞蓟素/水飞蓟宾需要进一步的临床研究。
