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Radiotherapy is a commonly used treatment for cancer and is usually given invarying doses. At low radiation doses relatively few cells die as a directresponse to radiation but secondary radiation effects such as DNA mutation orbystander effects affect many cells. Consequently it is at low radiation levelswhere an understanding of bystander effects is essential in designing noveltherapies with superior clinical outcomes. In this article, we use a hybridmultiscale mathematical model to study the direct effects of radiation as wellas radiation-induced bystander effects on both tumour cells and normal cells.We show that bystander responses may play a major role in mediating radiationdamage to cells at low-doses of radiotherapy, doing more damage than that dueto direct radiation. The survival curves derived from our computationalsimulations showed an area of hyper-radiosensitivity at low-doses that are notobtained using a traditional radiobiological model.

Bystander effects and their implications for clinical radiation therapy: Insights from multiscale in silico experiments