Preclinical studies demonstrate that amifostine has the potential to selectively 
protect normal tissues from the harmful effects of radiation without 
significantly protecting neoplastic tissue. The potential value of such an agent 
includes reducing treatment-related toxicity and the opportunity for radiation 
dose escalation in the curative treatment of cancer. An increasing number of 
human clinical trials have been conducted that define the toxicity profile and 
efficacy of radioprotection by amifostine when used during fractionated 
radiation therapy. These trials demonstrate that amifostine is safe and 
practical to administer in the outpatient setting during fractionated radiation 
therapy. These studies also illustrate the challenge of accurately evaluating 
the end point of radioprotection in the clinical setting. This article reviews 
the recent clinical literature on amifostine, the evidence for normal tissue 
protection, and the lack of tumor protection by this agent, and suggests 
possible avenues for future investigation and application of this agent in the 
field of radiation oncology.