Knowledge of the biochemical and molecular basis of sensitivity to ionizing radiation will provide useful information regarding carcinogenesis, cancer proneness and patient responses to radiotherapy. Cellular endpoints following irradiation are primarily the product of the induction, processing and manifestation of DNA damage. There are therefore several points in the postirradiation sequelae that can be altered to modify the sensitivity of a cell. At the present time there is no consensus as to the single most important determinant of radiosensitivity, but maybe this is because it does not exist. There could be a basic cellular characteristic, such as DNA conformation, which can influence every aspect of the cellular response to radiation, but it is likely that the critical controlling steps differ in different cell systems.