International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationsOxygenation of squamous cell carcinoma of the head and neck: comparison of primary tumors, neck node metastases, and normal tissue
Introduction
Hypoxia decreases the radiosensitivity of tumors. In general, a 2 to 3 times higher radiation dose is needed to kill hypoxic cells, compared to well-oxygenated cells 1, 2. There is some evidence that the knowledge about tumor oxygenation may lead to a more individualized radiation therapy. In the 1960s, direct measurements of the pO2tension by polarographic equipment became possible 3, 4. After the introduction of stainless-steel probes, invasive pO2 assessment has been shown to be clinically feasible in different human tissues. Many reports now describe hy-poxic regions in a multiplicity of human tumors 5, 6, 7, 8, 9, 10, 11, 12, 13, 14. For carcinoma of the cervix uteri, for human soft tissue sarcoma, and for squamous cell carcinoma in head and neck, the results of several authors suggest a relationship between pO2 status and patient outcome 15, 16, 17, 18.
In assessment of oxygenation of head and neck tumors, the majority of investigators have concentrated on neck node metastases. Data about pO2 tension of primary tumors are rare. Some groups have compared the results of pO2 measurements in carcinoma with the data of normal tissue—mostly subcutaneous tissue 12, 19, 20, 21, 22, 23. The objective of this study was to characterize the oxygenation of primary tumors, involved neck nodes, and normal tissue, and to compare the pO2 status of these regions in the same individual.
Section snippets
Patients and pO2 measurements
Between September 1996 and November 1997, we investigated, immediately before the onset of therapy, 30 patients with histologically proven advanced squamous cell carcinoma who were scheduled for definitive radio- or radiochemotherapy. All tumor manifestations were measured that could be reasonably reached with the electrode without causing too much discomfort to the patients. For measurements in healthy tissue, the contralateral sternocleidomastoid muscles have been used. We chose this muscle
Results
Pretreatment oxygenation status was assessed in 23 primary tumors, in 22 involved neck nodes, and in 30 contralateral sternocleidomastoid muscles. In 15 patients, we were able to perform measurements in their primary tumors, as well as in the lymph node metastases and the sternocleidomastoid muscles, respectively. In these cases, a highly significant correlation between the median pO2 of primary tumors and their neck node metastases was found (Fig. 1, p = 0.0001). The correlation between the
Discussion
In agreement with a number of other studies, the results of the presented paper show that the oxygenation status evaluated by polarographic measurements in squamous cell carcinoma of head and neck varies considerably from tumor to tumor 6, 8, 10, 20, 27, 29, 31. The assessment of these differences is complicated by a concurrent intratumoral heterogeneity of measurements 6, 13. Nordsmark et al. have demonstrated that more than one track is needed to overcome the variation and have recommended a
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2017, Advanced Drug Delivery ReviewsCitation Excerpt :Direct measurements of tumor hypoxia using Clark-type electrodes, often detect tumoral regions where O2 is < 5 mmHg (< 0.7%). [16] Indeed, the tumoral O2 in carcinomas of the breast, [18]cervix, [8,17,19] brain, [20,21] head and neck, [17,22,23] lung, [24] prostate [25] and sarcomas [7,26] ranges between 5.3 and 14 mmHg (0.7% – 1.8%). In contrast, normal tissue O2 measurements lie between 30 and 52 mmHg (3.9% – 6.8%) whereas arterial O2 levels lie between 75 and 100 mmHg (9.9% – 13.2%).
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