Hypoxia in Head and Neck Tumors: Characteristics and Development during Therapy

Bittner, Martin-Immanuel; Grosu, Anca‐Ligia

doi:10.3389/fonc.2013.00223

Cited by 17 publications

(11 citation statements)

References 53 publications

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“…All procedures for animal experiments were performed according to City of Hope guidelines and approved by the Institutional Animal Care and Use Committee. Four NOD/SCID [16][17][18] week old female mice were injected with 105 E0771 CEA+ breast cancer cells suspended 50 μl PBS and matrigel in equal parts. Cells were injected onto the mammary fat pad.…”

Section: Methodsmentioning

confidence: 99%

“…Based on the comparison of the IVDs with the experimental results for the two treated tumours, the simulation of tumours after a high dose was based on the data for tumour 4. Two patterns of hypoxia representative of clinical findings were considered: one in which the tumour oxygenation decreases towards the centre of the tumour, and one with a more heterogeneous pattern of multiple islands not located in the centre of the tumour (18). Figure 2 shows the cross sections through the simulated tumours with and without radiation-induced vessel collapse.…”

Section: Methodsmentioning

confidence: 99%

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Radiation-induced Vascular Damage and the Impact on the Treatment Outcome of Stereotactic Body Radiotherapy

et al. 2019

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Background/Aim: The aim of this study was to investigate radiation-induced tumour vascular damage and its impact thereof on the outcome of stereotactic body radiotherapy (SBRT). Materials and Methods: Vessel densities in animal tumours before and after a single dose of 20 Gy were quantified and used as input for simulations of three-dimensional tumours with heterogeneous oxygenation. SBRT treatments of the modelled tumours in 1-8 fractions were simulated. The impact of vessel collapse on the outcome of SBRT was investigated by calculating tumour control probability (TCP) and the dose required to obtain a TCP of 50% (D 50). Results: A radiationinduced increase of acute hypoxia in tumours during SBRT treatment could be simulated based on the experimental data. The D 50 values for these tumours were higher than for the simulated tumours without vessel collapse. Conclusion: The vascular changes after high doses of radiation could compromise the outcome of SBRT by increasing tumour hypoxia.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Radiation-induced Vascular Damage and the Impact on the Treatment Outcome of Stereotactic Body Radiotherapy

et al. 2019

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“…parts of the tumor could receive only 54 Gy in eight fractions, which is several Gy below the HTV doses calculated in the present work for a treatment consisting of eight fractions. As it is not safe to assume that hypoxic regions are located in the center of the tumor where the highest doses would be delivered in SBRT, the need for comprehensive pretreatment assessment of the tumor oxygenation in SBRT is further highlighted.…”

Section: Discussionmentioning

confidence: 99%

Impact of SBRT fractionation in hypoxia dose painting — Accounting for heterogeneous and dynamic tumor oxygenation

Lindblom

Ureba

Daşu³

et al. 2019

Medical Physics

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Purpose Tumor hypoxia, often found in nonsmall cell lung cancer (NSCLC), implies an increased resistance to radiotherapy. Pretreatment assessment of tumor oxygenation is, therefore, warranted in these patients, as functional imaging of hypoxia could be used as a basis for dose painting. This study aimed at investigating the feasibility of using a method for calculating the dose required in hypoxic subvolumes segmented on 18F‐HX4 positron emission tomography (PET) imaging of NSCLC. Methods Positron emission tomography imaging data based on the hypoxia tracer 18F‐HX4 of 19 NSCLC patients were included in the study. Normalized tracer uptake was converted to oxygen partial pressure (pO2) and hypoxic target volumes (HTVs) were segmented using a threshold of 10 mmHg. Uniform doses required to overcome the hypoxic resistance in the target volumes were calculated based on a previously proposed method taking into account the effect of interfraction reoxygenation, for fractionation schedules ranging from extremely hypofractionated stereotactic body radiotherapy (SBRT) to conventionally fractionated radiotherapy. Results Gross target volumes ranged between 6.2 and 859.6 cm3, and the hypoxic fraction < 10 mmHg between 1.2% and 72.4%. The calculated doses for overcoming the resistance of cells in the HTVs were comparable to those currently prescribed in clinical practice as well as those previously tested in feasibility studies on dose escalation in NSCLC. Depending on the size of the HTV and the distribution of pO2, HTV doses were calculated as 43.6–48.4 Gy for a three‐fraction schedule, 51.7–57.6 Gy for five fractions, and 59.5–66.4 Gy for eight fractions. For patients in whom the HTV pO2 distribution was more favorable, a lower dose was required despite a bigger volume. Tumor control probability was lower for single‐fraction schedules, while higher levels of tumor control probability were found for schedules employing several fractions. Conclusions The method to account for heterogeneous and dynamic hypoxia in target volume segmentation and dose prescription based on 18F‐HX4‐PET imaging appears feasible in NSCLC patients. The distribution of oxygen partial pressure within HTV could impact the required prescribed dose more than the size of the volume.

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“…Possible reasons may be cancer stem cells or tumor hypoxia. Targeting cancer stem cell molecules with monoclonal antibodies or pharmaceutical agents, or using hypoxia imaging to address hypoxic subvolumes through dose painting delivering higher doses to potentially more radioresistant parts of a tumor, may provide chances to overcome infield failure of OCC in future 31,34…”

Section: Discussionmentioning

confidence: 99%

Clinical effectiveness, toxicity, and failure patterns of helical tomotherapy for postoperative oral cavity cancer patients

Hsieh¹,

Shueng²,

Wang³

et al. 2014

OTT

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BackgroundThe outcome of postoperative high- and intermediate-risk oral cavity cancer (OCC) patients receiving helical tomotherapy (HT) remains limited.Materials and methodsBetween November 2006 and November 2012, 53 postoperative high- and intermediate-risk OCC patients treated with HT were enrolled.ResultsThe 4-year locoregional, local, and regional control rates were 66%, 76.4%, and 94.3%, respectively. The 4-year locoregional control rates of oral tongue and buccal mucosa cancer were 88.3% and 37.1%, respectively (P=0.012). Eleven (20.8%) patients experienced locoregional failure. In-field failure occurred in six of 53 (11.3%) in the primary area and three of 53 (5.7%) in the regional lymph-node area. No marginal failure was noted. Two of 53 (3.8%) experienced out-of-field failure. The rates of grade 3 dermatitis, mucositis, and dysphagia were 11%, 34%, and 13%, respectively. No grade 3 xerostomia was noted. Grade 2 xerostomia was 33% at month 6 and declined to 0 at month 48. A rate of 56% of grade 2 trismus at month 6 was noted, and declined to around 30% after 2 years. No grade 3 trismus was noted after 2 years.ConclusionHT as a postoperative modality provided satisfying results, especially for xerostomia and trismus, and was impressive in high- and intermediate-risk OCC patients receiving postoperative HT.

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Hypoxia in Head and Neck Tumors: Characteristics and Development during Therapy

Cited by 17 publications

References 53 publications

Radiation-induced Vascular Damage and the Impact on the Treatment Outcome of Stereotactic Body Radiotherapy

Radiation-induced Vascular Damage and the Impact on the Treatment Outcome of Stereotactic Body Radiotherapy

Impact of SBRT fractionation in hypoxia dose painting — Accounting for heterogeneous and dynamic tumor oxygenation

Clinical effectiveness, toxicity, and failure patterns of helical tomotherapy for postoperative oral cavity cancer patients

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