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LIFE01200604005 Shri Somnath Ghosh - Homi Bhabha National ...

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CHAPTER 4<br />

DISCUSSION<br />

Ionising radiation (IR) has been used for nearly a century to treat human cancers. The objective<br />

of radiotherapy is to deliver a lethal dose to cancer cells but attenuate the toxic effects of IR on<br />

adjacent normal tissue. In order to achieve this, radiotherapy is given as fractionated dose<br />

ranging from 2-4 Gy per fraction. Therefore, the manner in which cell senses and respond to<br />

radiation damage is critical for the outcome of radiotherapy. The molecular pathways that are<br />

triggered by acute dose of irradiation will be different from fractionated dose of irradiation. This<br />

will ultimately determine the multiple possible responses, whether they be DNA repair, cell<br />

cycle arrest, cell death or cell adaptive response. Moreover, these pathways provide molecular<br />

explanation of why different cell types differ in their response to radiation. Some cell types are<br />

relatively more radioresistant than others. The reason for the radioresistance could, therefore be<br />

efficient DNA repair, but cannot be the sole reason for it. The contribution of signaling to these<br />

phenomena could be enormous. Radioresistant cells and cells that become radioresistant after<br />

radiation treatment need newer modalities of irradiation like heavy ions because the relative<br />

biological effectiveness (RBE) increases with an increase in the LET of the incident radiation.<br />

The effectiveness of Ionising radiation is because it induces DNA damage, which generates a<br />

complex cascade of events leading to cell cycle arrest, transcriptional and post-transcriptional<br />

activation of a subset of genes including those associated with DNA repair and triggering<br />

apoptosis. Probably the most dangerous of all the types of DNA damage are double strand breaks<br />

(DSBs) and their repair is complex. Moreover, the degree of lesion complexity increases with<br />

increasing LET. The cellular genotoxic response depends on the type of DNA damage which in<br />

turn can evoke unique cellular response.<br />

The signaling events seen in totality may also have contribution from the surrounding<br />

microenvironment that is of necessity exposed to radiation. The cells nearby which are not<br />

186

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