Purpose: Is retention of γH2AX foci useful as a biomarker for predicting the response of xenograft tumors to cisplatin with X-ray? Is a similar approach feasible using biopsies from patients with cervical cancer? Experimental Design: Mice bearing SiHa, WiDr, or HCT116 xenograft tumors were exposed to cisplatin and/or three daily doses of 2 Gy. Tumors were excised 24 h after treatment and single cells were analyzed for clonogenic fraction and retention of γH2AX foci. Tumor biopsies were examined using 47 paraffin-embedded sections from untreated tumors and 24 sections from 8 patients undergoing radiochemotherapy for advanced cancer of the cervix. Results: Residual γH2AX measured 24 h after cisplatin injection accurately predicted surviving fraction in SiHa and WiDr xenografts. When a clinically equivalent protocol using cisplatin and fractionated irradiation was employed, the fraction of xenograft cells lacking γH2AX ranked survival accurately but underestimated tumor cell kill. Residual γH2AX foci were detected in clinical samples; on average, only 25% of tumor nuclei exhibited one or more γH2AX foci before treatment and 74% after the start of treatment. Conclusion: γH2AX can provide useful information on the response of human tumors to the combination of cisplatin and radiation, but prediction becomes less accurate as more time elapses between treatment and tumor biopsy. Use of residual γH2AX as a biomarker for response is feasible when cell survival exceeds ∼20%, but heterogeneity in endogenous and treatment-induced γH2AX must be considered.Prediction of tumor response to radiation remains an important goal in radiotherapy (1, 2). However, prediction is complicated by the use of combined modality therapy and the lack of a simple but effective predictor of response in situ. Ionizing radiation and many cancer therapeutics cause phosphorylation of histone H2AX at sites of individual DNA double-strand breaks, providing an exceptionally sensitive method for detection of this critical lesion (3, 4). Production of γH2AX foci can be detected microscopically or by using flow cytometry, and the extent of phosphorylation has been used as a biomarker of both exposure and DNA repair capacity (5-9). The fraction of cells that retain of γH2AX foci, measured 24 h after exposure to either radiation (6) or cisplatin (10), is correlated with the fraction of cells that lose clonogenicity in SiHa and WiDr tumor cells. These in vitro results and the availability of biopsies from patients treated with cisplatin and radiation provided the motivation to examine the response of xenograft tumors to the combination of cisplatin and radiation and then to measure γH2AX expression in clinical biopsies.The presence of residual γH2AX was examined using three human tumor xenograft models growing subcutaneously in immunodeficient mice given a single dose of cisplatin, 2 Gy × three daily fractions of X-ray, or the combination. To determine the importance of tumor cell location relative to functional blood vessels, tumor cells were sorte...