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Cellular DNA is a primary target of ionizing radiation, which can cause a variety of direct and indirect damages. Direct damage includes single-strand breaks (SSBs), double-strand breaks (DSBs), base modifications, and abasic sites. Indirect damage, mediated by reactive oxygen species (ROS), leads to oxidized bases, additional SSBs and DSBs, and cross-linking. Complex lesions, consisting of multiple damages within a small region of DNA, are particularly difficult to repair. These damages can result in cell death, mutagenesis, carcinogenesis, and genomic instability. Cells activate repair pathways such as NHEJ, homologous recombination, and base excision repair. The extent of damage depends on the radiation dose and LET. Understanding IR-induced DNA damage is crucial for radiotherapy and assessing radiation risks.
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