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The molecular regulation of apoptosis and implications for radiation oncology.

One of the major goals of cancer research is to identify and understand the causes of cellular proliferation. The role of cell death, or lack thereof, in carcinogenesis, tumour growth, metastatic spread and response to treatment has been largely overlooked even though the morphology of apoptosis (programmed cell death) was clearly described over 20 years ago, and its importance in cancer speculated on at that time. Over the last 5 years, however, an explosion of research has focused on delineating the molecular components of the apoptotic pathways and examining the role of apoptosis in a tumour's growth and response to treatment. This review highlights the aspects of apoptosis most relevant to radiation oncologists and radiobiologists. The apoptotic pathways will be described, with attention to the stimuli that initiate apoptosis, the oncogenes and tumour suppressor genes that mediate apoptosis, and the effector enzymes (proteases and endonucleases) responsible for the execution of apoptosis. In addition, we review the effect of classically described radiobiology cell survival parameters-cell cycle stage, dose rate, linear energy transfer, oxygen, total dose, and fractionation-on radiation induced apoptosis.