The relevance of blood flow for the outcome of radiation treatments was already described by Schwartz in 1909. He noticed that skin reactions were less severe when the radium applicator was firmly pressed to the skin. It was Cramer in 1935 who gave the first suggestion of an 'oxygen effect'. He found that mouse mammary tumours with a well developed stroma and vascular network were more radiosensitive than tumours with a more delicate stromal component. He suggested that the radiosensitive tumours had a better blood supply and, consequently, were better oxygenated. Later, Gray et al (1953) established the importance of tumour oxygenation for radiotherapy.The tumour micro-environment is a key factor in tumour biology and has great impact on clinical radiotherapy as well as other cancer treatments. Single parameters such as polarographic pO 2 measurements and microvascular density have been demonstrated to be prognostic indicators in a variety of tumour types, including carcinomas of the head and neck (Gatenby et al, 1987;Dray et al, 1995;Zätterström et al, 1995;Jenssen et al, 1996;Nordsmark et al, 1996;Brizel et al, 1997). However, considering the complexity of the micro-environmental system, it is unlikely that a single parameter can reliably predict treatment outcome on an individual basis. Multiple parameter analysis will be necessary to acquire a better understanding of the tumour micro-environment and to obtain a 'predictive profile' which can guide the clinician in the selection of patients for new treatment strategies.A computerized image analysis system for multi-parameter analysis has been developed in our institute (Rijken et al, 1995). The method involves computer controlled microscopic scanning of immunohistochemically stained tissue sections. It allows quantitative and simultaneous analysis of vascular parameters, oxygenation status and proliferation parameters. We have recently published our experience with this method in xenografted human tumours (Bussink et al, 1998(Bussink et al, , 1999.We now apply this method also to tumour biopsies from patients with squamous cell carcinomas of the head and neck. Before a biopsy was taken, the patients were injected with Hypoxyprobe-1 (pimonidazole hydrochloride) as a hypoxia marker. Pimonidazole can easily be dissolved in saline, has a low toxicity, and an efficient tumour uptake. So far pimonidazole has proven to be an effective hypoxia marker for human tumours of the cervix and head and neck (Kennedy et al, 1997;Raleigh et al, 1998;. In the present study we report the results of the analysis of biopsy material from 21 patients with squamous cell carcinoma of the head and neck.
MATERIALS AND METHODS
PatientsPatients with primary laryngeal, oropharyngeal (stage III-IV) or hypopharyngeal (stage II-IV) squamous cell carcinomas were Summary Tumour oxygenation and vasculature are determinants for radiation treatment outcome and prognosis in patients with squamous cell carcinomas of the head and neck. In this study we visualized and quantified these factors which m...