Radiosensitizers

• Drugs that mimic oxygen or enhance DNA damage.

• Examples:

  • Nitromidazoles (misonidazole, nimorazole).

  • Hypoxic cell cytotoxins (tirapazamine).

Hyperbaric oxygen & carbogen breathing

• Delivering oxygen-rich gas mixtures during RT to improve tumor oxygenation.

Dose escalation / “Dose painting”

• Modern IMRT/VMAT or proton therapy can escalate dose to hypoxic regions identified on imaging.

Hypoxia-inducible factor (HIF) inhibitors

• Target transcription factors (HIF-1α, HIF-2α) that mediate adaptive responses to low oxygen.

• Under clinical trial for radiosensitization.