Changes in tumor oxygenation during combined treatment with split-course radiotherapy and chemotherapy in patients with head and neck cancer

Stadler, Peter F.; Feldmann, Horst Jürgen; Creighton, Charles; Kau, R. J.; Molls, M.

doi:10.1016/s0167-8140(98)00032-2

Cited by 61 publications

(43 citation statements)

References 22 publications

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“…The data are in agreement with changes in oxygenation found by Molls et al [59,60] and Stadler et al [77,78]. Both the experimental and ctinical investigations suggest that the oxygenation status is a dose-dependent tumor biological parameter and that radiation doses in the range of 30 to 70 Gy may lead to a considerable decrease in intratumoral pO2.…”

Section: Feldmann H J Et Al Oxygenation Status Of Human Tumors C~losupporting

confidence: 90%

“…measurements in patients under radiooncotogical treatment [17,20,22,40,50,58,59,77,78]. Fleckenstein et al [20] repeatedly measured pO_, in a metastasis of a squamous cell carcinoma during the course of radiation therapy.…”

Section: Changes In Tumor Oxygenation During Radiation Therapymentioning

confidence: 99%

“…Molls et al [59,60] and Stadler et al [77,78] investigated the pO2 changes in locally advanced head and neck carcinomas du¡ a radiochemotherapy schedule under systematic conditions within a well-defined protocol. A split-course treatment with a 2-weeks break after 30 Gy was performed (2 Gy/day to 70 Gy).…”

Section: Feldmann H J Et Al Oxygenation Status Of Human Tumors C~lomentioning

confidence: 99%

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Blood flow and oxygenation status of human tumors

1999

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There is a large body of evidence suggesting that blood ¡ and oxygenation of human tumors ate important research topics which may explain, in particular, resistance to radiation and to many antineoplastic drugs, which can limit the curability of solid tumors by radiotherapy and chemotherapy. This manuscirpt reviews the clinical investigations which have been perforrned regarding blood flow and oxygenation status of human tumors in radiation oncology. The possible uses and limitations of the prognostic significance and the changes under therapy measuring blood flow and oxygenation in human tumors were discussed. In addition, several aproaches were summarized, which can improve the microvascular 02 availability and perfusion-limited O2 delivery. The clinical data concerning the prognostic significance of blood flow, vascular function and oxygenation of human tumors are relevant for patient selection in clinical oncology. Strategies to improve traditional cancer therapy by modulation of the oxygenation status remain quite promising but more critical research and sophisticated clinical studies are necessary before its true potential is known.

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Section: Feldmann H J Et Al Oxygenation Status Of Human Tumors C~losupporting

confidence: 90%

Section: Changes In Tumor Oxygenation During Radiation Therapymentioning

confidence: 99%

Section: Feldmann H J Et Al Oxygenation Status Of Human Tumors C~lomentioning

confidence: 99%

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Blood flow and oxygenation status of human tumors

1999

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“…Hypoxia may be sustained or even increased during and at completion of radiation therapy or chemoradiation [5,8,9,21,22]. It is unclear if this phenomenon reflects continued disease activity (i.e., drug resistance), radiationinduced necrosis of tumor tissue (i.e., drug sensitivity), or simply a shift in the hypoxic/aerobic cell ratio.…”

Section: Significance Of Intratumoral Hypoxiamentioning

confidence: 99%

“…There appears to be a correlation between anemia and increased hypoxia in solid tumors [22,28,132]; however, this relationship and its relevance in the clinical setting remain controversial [12,80,119]. Acute changes in hemoglobin are known to alter intratumoral hypoxia and reduce radiosensitivity [133], but the effect of chronic anemia, which is more common in cancer patients, is more difficult to estimate due to adaptive hematopoietic responses over time [12,134].…”

Section: Correction Of Anemiamentioning

confidence: 99%

Impact of Tumor Hypoxia and Anemia on Radiation Therapy Outcomes

et al. 2002

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Local recurrence remains a major obstacle to achieving cure of many locally advanced solid tumors treated with definitive radiation therapy. The microen-vironment of solid tumors is hypoxic compared with normal tissue, and this hypoxia is associated with decreased radiosensitivity. Recent preclinical data also suggest that intratumoral hypoxia, particularly in conjunction with an acid microenvironment, may be directly or indirectly mutagenic. Investigations of the prognostic significance of the pretreatment oxygenation status of tumors in patients with head and neck or cer-vical cancer have demonstrated that increased hypoxia, typically designated in these studies as pO 2 levels below 2.5-10 mm Hg, is associated with decreased local tumor control and lower rates of disease-free and overall survival. Hypoxia-directed therapies in the radiation oncology setting include treatment using hyperbaric oxygen, fluosol infusion, carbogen breathing, and electron-affinic and hypoxic-cell sensitizers. These interventions have shown the potential to increase the effectiveness of curative-intent radiation therapy, demonstrating that the strategy of overcoming hypoxia may be a viable and important approach. Anemia is common in the cancer population and is suspected to contribute to intratu-moral hypoxia. A review of the literature reveals that a low hemoglobin level before or during radiation therapy is an important risk factor for poor locoregional disease control and survival, implying that a strong correlation could exist between anemia and hypoxia (ulti-mately predicting for a poor outcome). While having a low hemoglobin level has been shown to be detrimental, it is unclear as to exactly what the threshold for "low" should be (studies in this area have used thresholds ranging from 9-14.5 g/dl). Optimal hemoglobin and pO 2 thresholds for improving outcomes may vary across and within tumor types, and this is an area that clearly The Oncologist 2002;7:492-508 www.TheOncologist.com The Oncologist ® LEARNING OBJECTIVES After completing this course, the reader will be able to: 1. Discuss the prognostic significance of intratumoral hypoxia and low hemoglobin levels in patients receiving curative-intent radiation for head and neck or cervical cancer. 2. Describe the potential relationship between anemia and intratumoral hypoxia in patients with solid tumors. 3. List possible interventions for improving intratumoral oxygenation and radiosensitivity in the radiation oncology setting. Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com

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