Hypoxic cell sensitizers and heavy charged particle beams may play complementary roles in killing hypoxic tumor cells.

The analysis of growth delay data of a rat rhabdomyosarcoma tumor system with and without misonidazole and irradiated with spread-peak heavy-ion radiation yields two conclusions that bear on the relative efficacy of the two modes of treatment and imply a complementary role of the two modes which enhances the effects of either given separately. 1. For both carbon and neon ion peak radiation given in four fractions, RBE values for tumor growth delay are significantly greater than the enhancement ratio for an X ray plus misonidazole fractionation scheme [2.0-2.3 (carbon) and 2.6-2.8 (neon) vs. 1.2-1.5 (X rays plus misonidazole)]. This implies that high LET killing is considerably more effective in this tumor system (hypoxic fraction of about 35%) than the hypoxic cell sensitization caused by misonidazole. 2. When misonidazole is given in conjunction with the heavy ion beam irradiations, an increased growth delay is seen, greater than when either heavy ions or misonidazole plus X rays are given separately. The product of the sensitizer enhancement ratio for heavy ions and the RBE for no sensitizer yields a measure of the overall enhancement of effect relative to an X ray treatment. The values of this product for the carbon beam (2.4-2.5) and neon beam (3.4) show high effectiveness for either beam plus misonidazole. The interpretation is that heavy ion beams reach and kill hypoxic cells not penetrated by the misonidazole, and some hypoxic cells not killed by the high LET component receive low LET damage which is made lethal by the drug. Thus, the net hypoxic cell killing is enhanced by the high LET beams and in a complementary way by the combination of the drug and the low LET portion of the radiation.