Youssef Andrew, Sahgal Arjun, Das Sunit
Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, Toronto, ON, Canada.
Front Oncol. 2024 Oct 30;14:1477448. doi: 10.3389/fonc.2024.1477448. eCollection 2024.
Intracranial metastatic disease is a serious complication of cancer, treated through surgery, radiation, and targeted therapies. The central role of radiation therapy makes understanding the radioresistance of metastases a key interest for prognostication and therapeutic development. Although historically defined clinic-radiographically according to tumour response, developments in new techniques for delivering radiation treatment and understanding of radioprotective mechanisms led to a need to revisit the definition of radioresistance in the modern era. Factors influencing radioresistance include tumour-related factors (hypoxia, cancer stem cells, tumour kinetics, tumour microenvironment, metabolic alterations, tumour heterogeneity DNA damage repair, non-coding RNA, exosomes, methylomes, and autophagy), host-related factors (volume effect & dose-limiting non-cancerous tissue, pathophysiology, and exosomes), technical factors, and probabilistic factors (cell cycle and random gravity of DNA damage). Influences on radioresistance are introduced and discussed in the context of brain metastases.
颅内转移性疾病是癌症的一种严重并发症，可通过手术、放疗和靶向治疗进行治疗。放射治疗的核心作用使得了解转移灶的放射抗性成为预后和治疗发展的关键关注点。尽管历史上根据肿瘤反应在临床影像学上进行定义，但放射治疗新技术的发展以及对放射防护机制的理解导致有必要重新审视现代时代放射抗性的定义。影响放射抗性的因素包括肿瘤相关因素（缺氧、癌症干细胞、肿瘤动力学、肿瘤微环境、代谢改变、肿瘤异质性、DNA损伤修复、非编码RNA、外泌体、甲基化组和自噬）、宿主相关因素（体积效应和剂量限制非癌组织、病理生理学和外泌体）、技术因素和概率因素（细胞周期和DNA损伤的随机严重性）。本文将在脑转移的背景下介绍和讨论对放射抗性的影响。
