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Exploring hypoxic biology to improve radiotherapy outcomes

Li, Chun; Wiseman, Lucy; Okoh, Ene; Lind, Michael; Roy, Rajarshi; Beavis, Andrew; Monteiro dos Santos Pires, Isabel


Chun Li

Lucy Wiseman

Ene Okoh

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Professor Michael Lind
Foundation Professor of Oncology/ Head of the Joint Centre for Cancer Studies

Rajarshi Roy

Isabel Monteiro dos Santos Pires


Ionising radiotherapy is a well-established, effective cancer treatment modality, whose efficacy has improved with the application of newer technological modalities. However, patient outcomes are governed and potentially limited by aspects of tumour biology that are associated with radioresistance. Patients also still endure treatment associated toxicities owed to the action of ionising radiation in normoxic tissue adjacent to the tumour mass. Tumour hypoxia is recognised as key component of the tumour microenvironment and is well established as leading to therapy resistance and poor prognosis.
In this review, we outline the current understanding of hypoxia-mediated radiotherapy resistance, before exploring targeting tumour hypoxia for radiotherapy sensitisation to improve treatment outcomes and increase the therapeutic window. This includes increasing oxygen availability in solid tumours, the use of hypoxia activated pro-drugs (HAPs), targeting of hypoxia-regulated or associated signalling pathways, as well as the use of high-LET radiotherapy modalities. Ultimately, targeting hypoxic radiobiology combined with precise radiotherapy delivery modalities and modelling should be associated with improvement to patient outcomes.


Li, C., Wiseman, L., Okoh, E., Lind, M., Roy, R., Beavis, A., & Monteiro dos Santos Pires, I. (2022). Exploring hypoxic biology to improve radiotherapy outcomes. Expert Reviews in Molecular Medicine, 24, Article E21.

Journal Article Type Article
Acceptance Date Apr 12, 2022
Online Publication Date Apr 27, 2022
Publication Date 2022
Deposit Date Apr 27, 2022
Publicly Available Date Oct 28, 2022
Journal Expert Reviews in Molecular Medicine
Print ISSN 1462-3994
Publisher Cambridge University Press
Peer Reviewed Peer Reviewed
Volume 24
Article Number E21
Public URL


Accepted manuscript (707 Kb)

Copyright Statement
Copyright © The Author(s), 2022. Published by Cambridge University Press

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