Radiotherapy toxicities: mechanisms, management, and future directions

Cet article présente les mécanismes à l'origine des effets secondaires aigus et à long terme de la radiothérapie, passe en revue les stratégies pour réduire ses effets indésirables et limiter leur gravité puis examine les avantages potentiels des technologies émergentes et des approches innovantes pour améliorer la précision de la radiothérapie et minimiser les effets hors cible

Résumé en anglais

For over a century, radiotherapy has revolutionised cancer treatment. Technological advancements aim to deliver high doses to tumours with increased precision while minimising off-target effects to organs at risk. Despite advancements such as image-guided, high-precision radiotherapy delivery, long-term toxic effects on healthy tissues remain a great clinical challenge. In this Review, we summarise common mechanisms driving acute and long-term side-effects and discuss monitoring strategies for radiotherapy survivors. We explore ways to mitigate toxic effects through novel technologies and proper patient selection and counselling. Additionally, we address policies and management strategies to minimise the severity and impact of toxicity during and after treatment. Finally, we examine the potential advantages of emerging technologies and innovative approaches to improve conformity, accuracy, and minimise off-target effects.