Antineoplastic drugs and radiation: comparison of the phenomena determining the effectiveness of fractionated treatments

In the last ten years the criteria for effective radiotherapy regimens have been rediscussed by analyzing the dependence of radiation response upon the radiobiological phenomena affecting the results of fractionated treatments. In the original definition of H.R. Withers, these phenomena have been referred to as the four R's of radiotherapy, and today we suspect that their number may be higher than that. By analogy, and in spite of the fact that chemical cytotoxic agents are seldom radiomimetic in the strict sense of the word, a similar general analysis could be used to discuss the effectiveness of fractionated administrations of anti-neoplastic drugs. However, information is only available for the cell-cycle age-dependence of lethal and kinetic effects and the repair from potentially lethal damage induced by these agents. In the present work, an attempt is made to discuss some of the neglected R's of chemotherapy, with the aim of establishing (not exclusively empirical) criteria for drug scheduling and of clarifying some of the observations on interaction between agents. In particular, with regard to antineoplastic drugs, published and unpublished information is available not only for the well-known phenomenon of reassortment, but also for the shape of the survival curve, recovery (or potentiation) between dose fraction, and recruitment. Some advantages (and pitfalls) can be evidenced when applying this kind of radiobiological approach to chemotherapy