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. Author manuscript; available in PMC: 2016 Jun 7.
Published in final edited form as: Nat Rev Cancer. 2015 Jul;15(7):409–425. doi: 10.1038/nrc3958

Figure 5. The interconnected radiotherapy-mediated changes in the tumour microenvironment (TME).

Figure 5

Hypoxic regions within the TME may initially affect tumour radiosensitivity. Radiotherapy elicits an inflammatory response in the TME as well as contributing to cycling hypoxia and modulation of CAF activity. These responses are interconnected with immunomodulation, revascularisation, ECM remodelling, and radiation fibrosis that may impact tumour cell survival and/or tumour recurrence and metastasis. Similar processes may occur in the surrounding normal tissue that could result in irreparable damage to critical organs. These events must all be taken into account when combining radiotherapy with therapies to modulate the immune response as well as reducing hypoxia and ECM remodelling and fibrosis in carefully timed treatment strategies.