Unraveling the Mechanisms of Radiotherapy: Biological Pathways and Therapeutic Innovations
DOI:
https://doi.org/10.29384/rbfm.2025.v19.19849001826Palavras-chave:
Radiotherapy, radioresistance, radiotherapy response, cancerResumo
A radioterapia (RT) desempenha um papel fundamental na oncologia por ser uma das principais formas de tratamento para diversas neoplasias malignas. A RT utiliza princípios físicos, como a radiação ionizante, para danificar as células tumorais e inibir o crescimento tumoral. Avanços tecnológicos, como terapia de prótons, radioterapia com íons de carbono (CIRT) e radioterapia adaptativa (ART), aumentaram significativamente a precisão e a eficácia na entrega da radiação. No entanto, o efeito terapêutico da RT ainda é limitado por fatores como a heterogeneidade tumoral, toxicidade nos tecidos normais e a radiorresistência. Os efeitos biológicos da radiação, incluindo o dano ao DNA, parada do ciclo celular e apoptose, são influenciados por componentes do microambiente tumoral (TME) como a hipóxia, os quais contribuem para o desenvolvimento de resistência à RT. As nanopartículas tem se mostrado uma ferramenta promissora para superar essas limitações, através do direcionamento preciso da RT para a célula tumoral, aumentando a deposição local de radiação e modulando o TME. No entanto, questões relacionadas à biocompatibilidade e à toxicidade, especialmente em casos de exposições prolongadas, ainda precisam ser devidamente abordadas. Além disso, a integração da inteligência artificial (IA) e do machine learning (ML) no planejamento da radioterapia está revolucionando esta modalidade terapêutica. Essas tecnologias permitem uma delimitação mais precisa do tumor, planejamento personalizado do tratamento e a otimização das doses de radiação, melhorando os resultados terapêuticos. Para contornar a radiorresistência, terapias combinadas inovadoras que atuam simultaneamente nas células tumorais e no microambiente tumoral, associadas aos avanços em nanotecnologia e inteligência artificial, representam estratégias promissoras para potencializar a eficácia da RT e melhorar a sobrevivência dos pacientes.
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