Radiobiology has evolved from a mechanistic model based on DNA damage and response factors into a more complex model that includes effects on the immune system and the tumor microenvironment (TME). Irradiation has an immunomodulatory effect that can manifest as increased anti-tumor immunity or immunosuppression. Irradiation promotes an inflammatory microenvironment through the release of pro-inflammatory cytokines and endothelial damage, which recruit immune system cells to the irradiated area. Radiation-induced immunogenic cell death (ICD), characterized by the release of damage-associated molecular patterns (DAMPs) and tumor antigens, triggers an anti-tumor immune response of both innate and adaptive immunity. Anti-tumor immunity can manifest at a distance from the irradiated area, a phenomenon known as the abscopal effect (AE), which involves dendritic cells and CD8+ T cells. Irradiation also produces an immunosuppressive effect mediated by tumor-associated macrophages (TAMs) and regulatory T lymphocytes (Tregs), which counterbalances the immunostimulatory effect. In this work, we review the mechanisms involved in the radiation-induced immune response, which support the combined treatment of RT and immunotherapy, focusing, where possible, on gynecologic cancer.
放射生物学已从基于DNA损伤与应答因子的机械模型，演变为一个更为复杂的模型，该模型涵盖了对免疫系统及肿瘤微环境（TME）的影响。放射治疗具有免疫调节作用，既可表现为增强抗肿瘤免疫，也可导致免疫抑制。通过释放促炎细胞因子及造成内皮损伤，放射治疗促进炎症微环境的形成，从而募集免疫系统细胞至照射区域。放射诱导的免疫原性细胞死亡（ICD）以损伤相关分子模式（DAMPs）和肿瘤抗原的释放为特征，能够触发先天性与适应性免疫系统的抗肿瘤免疫应答。抗肿瘤免疫可在远离照射区域的部位显现，这一现象被称为远隔效应（AE），其过程涉及树突状细胞与CD8+ T细胞。同时，放射治疗亦通过肿瘤相关巨噬细胞（TAMs）和调节性T淋巴细胞（Tregs）介导产生免疫抑制效应，从而抵消其免疫刺激作用。本文综述了放射诱导免疫应答的相关机制，这些机制为放射治疗与免疫治疗的联合应用提供了理论支持，并尽可能聚焦于妇科肿瘤领域进行探讨。
The Effects of Gynecological Tumor Irradiation on the Immune System
肿瘤(癌症)患者之家