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This review examines significant advancements and ongoing challenges in simulating the complex interactions of ionizing radiation with cancer cells. We explore the utility and limitations of current\n                    <jats:italic toggle=\"yes\">in silico<\/jats:italic>\n                    models, including agent-based models and hybrid approaches that integrate cellular behavior with radiobiological effects using Monte Carlo tools. The paper highlights key developments that have enabled more accurate simulations of DNA damage, various repair processes, and the influence of the microenvironment on cellular radiosensitivity. Looking ahead, we address the need for further refinement of these models and their integration with experimental data to enhance predictive accuracy and potential clinical applications. 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