Lung cancer is one of the main causes of cancer mortality globally. Most patients received radiotherapy during the course of disease. However, radioresistance generally occurs in the majority of these patients, leading to poor curative effect, and the underlying mechanism remains unclear. In the present study, miRâ18aâ5p expression was downregulated in irradiated lung cancer cells. Overexpression of miRâ18aâ5p increased the radiosensitivity of lung cancer cells and inhibited the growth of A549 xenografts after radiation exposure. Dual luciferase report system and miRâ18aâ5p overexpression identified ataxia telangiectasia mutated (ATM) and hypoxia inducible factor 1 alpha (HIFâ1α) as the targets of miRâ18aâ5p. The mRNA and protein expressions of ATM and HIFâ1α were dramatically downregulated by miRâ18aâ5p in vitro and in vivo. Clinically, plasma miRâ18aâ5p expression was significantly higher in radiosensitive than in radioresistant group (P < .001). The cutoff value of miRâ18aâ5p >2.28 was obtained from receiver operating characteristic (ROC) curve. The objective response rate (ORR) was significantly higher in miRâ18aâ5pâhigh group than in miRâ18aâ5pâlow group (P < .001). A tendency demonstrated that the median local progressionâfree survival (PFS) from radiotherapy was longer in miRâ18aâ5pâhigh than in miRâ18aâ5pâlow group (P = .082). The median overall survival (OS) from radiotherapy was numerically longer in miRâ18aâ5pâhigh than in miRâ18aâ5pâlow group (P = .281). The sensitivity and specificity of plasma miRâ18aâ5p to predict radiosensitivity was 87% and 95%, respectively. Collectively, these results indicate that miRâ18aâ5p increases the radiosensitivity in lung cancer cells and CD133+ stemâlike cells via downregulating ATM and HIFâ1α expressions. Plasma miRâ18aâ5p would be an available indicator of radiosensitivity in lung cancer patients.