Mathematical modelling of oxygen supply and oxygenation in tumor tissues: prognostic, therapeutic, and experimental implications

18F-Fluoromisonidazole Quantification of Hypoxia in Human Cancer Patients Using Image-Derived Blood Surrogate Tissue Reference Regions

(18)F-fluoromisonidazole ((18)F-FMISO) is the most widely used PET agent for imaging hypoxia, a condition associated with resistance to tumor therapy. (18)F-FMISO equilibrates in normoxic tissues but is retained under hypoxic conditions because of reduction and binding to macromolecules. A simple tissue-to-blood (TB) ratio is suitable for quantifying hypoxia. A TB ratio threshold of 1.2 or greater is useful in discriminating the hypoxic volume (HV) of tissue; TBmax is the maximum intensity of the hypoxic region and does not invoke a threshold. Because elimination of blood sampling would simplify clinical use, we tested the validity of using imaging regions as a surrogate for blood sampling.

METHODS

Patients underwent 20-min (18)F-FMISO scanning during the 90- to 140-min interval after injection with venous blood sampling. Two hundred twenty-three (18)F-FMISO patient studies had detectable surrogate blood regions in the field of view. Quantitative parameters of hypoxia (TBmax, HV) derived from blood samples were compared with values using surrogate blood regions derived from the heart, aorta, or cerebellum. In a subset of brain cancer patients, parameters from blood samples and from the cerebellum were compared for their ability to independently predict outcome.

RESULTS

Vascular regions of heart showed the highest correlation to measured blood activity (R(2) = 0.84). For brain studies, cerebellar activity was similarly correlated to blood samples. In brain cancer patients, Kaplan-Meier analysis showed that image-derived reference regions had predictive power nearly identical to parameters derived from blood, thus obviating the need for venous sampling in these patients.

CONCLUSION

Simple static analysis of (18)F-FMISO PET captures both the intensity (TBmax) and the spatial extent (HV) of tumor hypoxia. An image-derived region to assess blood activity can be used as a surrogate for blood sampling in quantification of hypoxia.

Blood supply in melanoma xenografts is governed by the morphology of the supplying arteries

Tumor blood supply was related to the morphology of the tumor microvasculature and the supplying arteries (SAs) of A-07-GFP and D-12-GFP melanoma xenografts growing in window chamber preparations in BALB/c nu/nu mice. Blood supply and morphologic parameters were determined from first-pass imaging movies and vascular maps recorded after a bolus of 155-kDa tetramethylrhodamine isothiocyanate-labeled dextran had been administered intravenously. Poorly supplied tumors showed microvascular networks that did not differ from those of well-supplied tumors in vessel tortuosity, diameter, and density. Conversely, the SAs of poorly supplied tumors were more tortuous and had a smaller diameter than those of well-supplied tumors, resulting in lower plasma velocities in the downstream tumor vessels. Consequently, the blood supply of A-07-GFP and D-12-GFP tumors was governed by the geometric resistance of the SAs rather than by the geometric resistance or the vessel density of the tumor microvasculature. The present study suggests that the SAs may represent an important target for physiological interventions of tumors and that it may be beneficial to focus on the tumor SAs rather than the tumor microvasculature when searching for novel therapeutic strategies for modifying tumor blood supply.

Oncological implications of hypoxia inducible factor-1alpha (HIF-1alpha) expression

Solid tumours contain regions of hypoxia, which may be a prognostic indicator and determinant of malignant progression, metastatic development and chemoradio-resistance. The degree of intra-tumoural hypoxia has been shown to be positively correlated with the expression of the transcription factor hypoxia-inducible factor 1. HIF-1 is composed of 2 sub-units, namely HIF-1alpha and HIF-1beta. The production of hypoxia inducible factor 1-alpha has been identified as a key element in allowing cells to adapt and survive in a hostile hypoxic environment via a variety of pathways. HIF-1alpha is stabilised by hypoxia at the protein level, and also by the oncogenes HER2neu, v-src and ras. There are over 60 target genes for HIF-1, many of which are activated in cancers in comparison to equivalent normal tissues. Chemotherapeutic modulation of HIF-1 pathways has shown promise for patients with chemo-radio resistant or recurrent tumours in Phase II clinical trials. We herein review the existing literature on hypoxia inducible factor-1alpha, particularly its role in carcinogenesis and clinical implications of its over-expression.

Correction of anaemia through the use of darbepoetin alfa improves chemotherapeutic outcome in a murine model of Lewis lung carcinoma

Darbepoetin alfa (Aranesp®, Amgen) is a novel erythropoiesis-stimulating protein with a serum half-life longer than recombinant human erythropoietin (Epo), used in the treatment of cancer-associated anaemia. Anaemia is known to adversely affect prognosis and response to treatment in cancer patients. Solid tumours contain regions of hypoxia due to poor vascular supply and cellular compaction. Although hypoxic stress usually results in cell death, hypoxia-resistant tumour cells are genetically unstable and often acquire a drug-resistant phenotype. Increasing tumour oxygenation and perfusion during treatment could have the doubly beneficial outcome of reducing the fraction of treatment-resistant cells, while increasing drug delivery to previously hypoxic tissue. In this study, we examined the effect of darbepoetin alfa on chemotherapy sensitivity and delivery in an in vivo model of Lewis lung carcinoma, shown here to express the Epo receptor (EpoR). We identified that weekly darbepoetin alfa treatment, commencing 10 days before chemotherapy, resulted in a significant reduction in tumour volume compared to chemotherapy alone. This was mediated by the prevention of anaemia, a reduction in tumour hypoxia and a concomitant increase in drug delivery. Darbepoetin alfa treatment alone did not modulate the growth of the EpoR-expressing tumour cells. This study identifies an important role for darbepoetin alfa in increasing the therapeutic index of chemotherapy.

Hypoxia and anemia: factors in decreased sensitivity to radiation therapy and chemotherapy?

Hypoxia is a common feature of solid tumors that occurs across a wide variety of malignancies. Hypoxia and anemia (which contributes to tumor hypoxia) can lead to ionizing radiation and chemotherapy resistance by depriving tumor cells of the oxygen essential for the cytotoxic activities of these agents. Hypoxia may also reduce tumor sensitivity to radiation therapy and chemotherapy through one or more indirect mechanisms that include proteomic and genomic changes. These effects, in turn, can lead to increased invasiveness and metastatic potential, loss of apoptosis, and chaotic angiogenesis, thereby further increasing treatment resistance. Investigations of the prognostic significance of pretreatment tumor oxygenation status have shown that hypoxia (oxygen tension [pO(2)] value < or =10 mmHg) is associated with lower overall and disease-free survival, greater recurrence, and less locoregional control in head and neck carcinoma, cervical carcinoma, and soft-tissue sarcoma. In view of the deleterious effect of hypoxia on standard cancer treatment, a variety of hypoxia- and anemia-targeted therapies have been studied in an effort to improve therapeutic effectiveness and patient outcomes. Early evidence from experimental and clinical studies suggests the administration of recombinant human erythropoietin (rHuEPO) may enhance the effectiveness of radiation therapy and chemotherapy by increasing hemoglobin levels and ameliorating anemia in patients with disease- or treatment-related anemia. However, further research is needed in the area of hypoxia-related treatment resistance and its reversal.

Darbepoietin Alfa Potentiates the Efficacy of Radiation Therapy in Mice with Corrected or Uncorrected Anemia

Darbepoietin alfa (DA) is a long-acting analogue of erythropoietin that has reduced receptor affinity and enhanced biological activity. Experiments were done to test the hypothesis that correction of anemia in tumor-bearing mice by DA would increase tumor oxygenation and potentiate radiation-induced tumor cell killing. A SCC VII tumor model was used to study tumor responses to fractionated radiation therapy in mice with anemia induced by total body irradiation. Administration of DA reduced the extent and duration of anemia and associated tumor hypoxia, protected the bone marrow cells and prevented the body weight loss from the effect of irradiation, and facilitated the recovery in a time-dependent manner, with the administration of DA prior to total body irradiation having the greatest protective effect. When combined with fractionated radiation therapy, DA increased the tumor growth delay time from 2.7 days for irradiation alone to 7.3 to 10.6 days for combination of DA and irradiation. The effect of DA on tumor responses to fractionated radiation therapy was observed when DA was given 18 to 4 days before starting radiation therapy, but DA was also equally effective as a radiosensitizer when given only 2 hours before fractionated irradiation therapy. Weekly dosing of DA was as efficacious for the enhancement of radiation responses of tumors as biweekly dosing. Similar results were obtained in the RIF-1 fibrosarcoma tumor model. These studies show that DA can effectively correct anemia in tumor-bearing mice and sensitize tumor cells to fractionated radiation therapy. Importantly, DA was also able to sensitize tumors to radiation in mice with uncorrected anemia and hypoxia, suggesting that the effect of DA on radiosensitivity was independent of these factors and a different mechanism of action may be responsible for this effect.

Impact of anemia in patients with head and neck cancer treated with radiation therapy

Locoregional recurrence remains a major obstacle to achieving a cure of locally advanced head and neck cancers, despite multimodality therapy. Multiple studies report that a low hemoglobin (Hgb) before or during radiation therapy is an important risk factor for poor locoregional disease control and survival. Anemia is common in the head and neck cancer population and is suspected to contribute to intratumoral hypoxia with resultant radioresistance. Although having a low Hgb level has been shown to be detrimental, it is unclear as to exactly what the threshold should be for low Hgb (studies in this area have used thresholds ranging from 9-14.5 g/dL). Quality-of-life studies suggest that correction of moderately severe anemia may result in significant gains. Optimal Hgb levels for improving outcomes may vary across and within tumor types, and this is an area that requires further evaluation. However, the correction of anemia may be a worthwhile strategy for radiation oncologists to improve local control and survival. This article reviews the impact of anemia on outcomes after radiotherapy of head and neck cancers.

Impact of tumor hypoxia and anemia on radiation therapy outcomes

Local recurrence remains a major obstacle to achieving cure of many locally advanced solid tumors treated with definitive radiation therapy. The microenvironment 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 cervical 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 intratumoral 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 (ultimately 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 requires further evaluation. Nonetheless, the correction of anemia may be a worthwhile strategy for radiation oncologists to improve local control and survival.

Improvement of tumor response by manipulation of tumor oxygenation during photodynamic therapy

Photodynamic therapy (PDT) requires molecular oxygen during light irradiation to generate reactive oxygen species. Tumor hypoxia, either preexisting or induced by PDT, can severely hamper the effectiveness of PDT. Lowering the light irradiation dose rate or fractionating a light dose may improve cell kill of PDT-induced hypoxic cells but will have no effect on preexisting hypoxic cells. In this study hyperoxygenation technique was used during PDT to overcome hypoxia. C3H mice with transplanted mammary carcinoma tumors were injected with 12.5 mg/kg Photofrin and irradiated with 630 nm laser light 24 h later. Tumor oxygenation was manipulated by subjecting the animals to 3 atp (atmospheric pressure) hyperbaric oxygen or normobaric oxygen during PDT light irradiation. The results show a significant improvement in tumor response when PDT was delivered during hyperoxygenation. With hyperoxygenation up to 80% of treated tumors showed no regrowth after 60 days. In comparison, when animals breathed room air, only 20% of treated tumors did not regrow. To explore the effect of hyperoxygenation on tumor oxygenation, tumor partial oxygen pressure was measured with microelectrodes positioned in preexisting hypoxic regions before and during the PDT. The results show that hyperoxygenation may oxygenate preexisting hypoxic cells and compensate for oxygen depletion induced by PDT light irradiation. In conclusion, hyperoxygenation may provide effective ways to improve PDT efficiency by oxygenating both preexisting and treatment-induced cell hypoxia.

The modification of human tumour blood flow using pentoxifylline, nicotinamide and carbogen

AIM

To assess the effect of combining oral nicotinamide, oral pentoxifylline and carbogen gas (2% CO2, 98% O2) breathing on human tumour red cell flux.

METHODS AND MATERIALS

Microregional red blood cell flux was measured in accessible tumour nodules using laser Doppler microprobes in 11 patients with histologically proven malignancy. Patients received single oral doses of nicotinamide 40 mgkg-1 and pentoxifylline 1200 mg 2h before a 10-min period of carbogen gas breathing, corresponding to peak plasma concentrations of these drugs. Red cell flux in up to six microregions in each tumour was measured for 30 min, recording pre-, during and post-carbogen breathing for 10 min each.

RESULTS

Data from ten of the 11 patients could be assessed. The red cell flux in 48 microregions was analysed and the mean red cell flux was calculated. A mean relative increase in red cell flux of 1.18 (+/-0.09, 95% confidence interval (CI)) was observed after 6 min of carbogen breathing, 2h after the administration of nicotinamide and pentoxifylline. This compares to relative increases of 1.4 (+/-0.39, 95%CI) after nicotinamide with carbogen and 1.15 (+/-0.10, 95%CI) after pentoxifylline with carbogen. These differences are not statistically significant (P>0.05). The increased red cell flux persisted after the cessation of carbogen gas breathing.

CONCLUSIONS

A combination of pentoxifylline, nicotinamide and carbogen produces an increase in human tumour red cell flux, similar to that observed when each of the drugs are used alone with carbogen breathing.

Mathematical modeling of chronical hypoxia in tumors considering potential doubling time and hypoxic cell lifetime

PURPOSE

To model mathematically how potential doubling time and hypoxic cell lifetime affect the extent of chronical hypoxia in tumor tissue segments. Three capillary geometries were modeled under idealized steady state conditions.

MATERIALS AND METHODS

The capillary geometries are: tissue surrounding an axial capillary, tissue enclosed by a cylindrical capillary network, and tissue enclosed by a spherical capillary network. The tissue segments are modeled as three-compartment systems, where well nourished cells proliferate near the vasculature and, in so doing, displace 'older' cells into a quiescent compartment and, ultimately into a hypoxic region. The extent of the hypoxic zone is the distance traversed by cells during their hypoxic lifetime before becoming necrotic. The steady state situation, where the necrotic cell loss equals the cell gain caused by cell proliferation was investigated.

RESULTS

The hypoxic fraction, HF, was found to be inversely proportional to the potential doubling time of the tumor segment, T(pot), and proportional to the hypoxic cell lifetime, T(hypox). The extent of the oxygenated zone depends only on the capillary geometry, the capillary radius, the intracapillary oxygen tension, and the tissue respiration rate. The extent of the hypoxic zone in addition depends on T(pot) and T(hypox).

CONCLUSIONS

Mathematical modeling of idealized steady state conditions shows that the ratio of hypoxic cell lifetime and potential doubling time, T(hypox)/T(pot), determines the hypoxic fraction, HF, in tumor segments. The extents of the oxygenated and the hypoxic zones can be predicted from the models.

Characterization of angiogenesis and microcirculation of high-grade glioma: an intravital multifluorescence microscopic approach in the athymic nude mouse

The current study follows angiogenesis and microcirculatory changes associated with malignant glioma growth by means of an intravital fluorescence microscopic approach, which allows for the direct and continuous visualization of the glioma microvasculature and its quantitative analysis. Fluorescently labeled C6 rat glioma cells (5 x 10(5)) were implanted into dorsal skinfold chamber preparations of athymic nude mice. Glioma growth, vascularization, microhemodynamics, vascular permeability, and leukocyte-endothelial cell interactions were simultaneously followed over a 22-day observation period using intravital epiillumination microscopy and a multifluorescent labeling technique. Analysis of the process of glioma vascularization revealed three stages with distinct microvascular characteristics: avascular stage (days 0 to 6), lag of glioma growth but initial glioma-induced angiogenesis within the host tissue in peritumoral areas; early vascular stage (days 6 to 14), glioma cell proliferation associated with a spatially homogeneous development of a glioma microvasculature; and late vascular stage (days 14 to 22), exponential tumor growth and expansion (> 400 mm3) with high vascular densities in the peritumoral region and reduced vascularization (microvascular perfusion) in the glioma center. Within the center, the functional vessel length per area correlated inversely with glioma size (P < 0.01). In the peritumoral region, functional vessel length per area was independent of glioma size, indicating persistent, high angiogenic activity throughout the observation period. Thus, the microvasculature of mature gliomas revealed a microvascular zonal division with a progressive reduction of the functional vessel length per area within the tumor center. The perfusion failure of individual microvessels within the glioma center was partly compensated by an increase of diameters (P < 0.05), and thus by an increase of blood flow in these functional microvessels (P < 0.05) over time. Histologic analysis demonstrated both expanding and infiltrating growth patterns, as well as focal necroses on day 22. These are the first data from repeated in vivo analysis of glioma growth, vascularization, and microcirculation.

T1/T2 glottic cancer managed by external beam radiotherapy: the influence of pretreatment hemoglobin on local control

PURPOSE

Pretreatment hemoglobin (Hb) level has been reported to be an important prognostic factor for local control and survival in various malignancies. However, in many settings, the adverse effect of a low Hb may be related to more advanced disease. The purpose of this analysis was to assess the influence of pretreatment Hb on local control in a large series of patients with a localized cancer (T1/T2 glottic cancer, AJCC 1992) treated in a standard fashion.

MATERIALS AND METHODS

Between January 1981 and December 1989, 735 patients (median age 63; 657 males, 78 females) with T1/T2 glottic cancer were treated with radiation therapy (RT). The standard RT prescription was 50 Gy in 20 fractions over 4 weeks (97% of patients). Factors studied for prognostic importance for local failure included pretreatment Hb, age, sex, T category, anterior commissure involvement, subglottic extension, and tumor bulk (presence of visible tumor vs. subclinical disease).

RESULTS

With a median follow-up of 6.8 years (range 0.2-14.3), 131 patients have locally relapsed for an actuarial 5-year relapse-free rate of 81.7%. The 5-year actuarial survival was 75.8%. The mean pretreatment hemoglobin level was 14.8 g/dl and was similar in all prognostic categories. On multivariate analysis, using the Cox proportional hazards model, pretreatment Hb predicted for local failure after RT. The hazard ratio (HR) for relapse was calculated for various Hb levels. For example, the HR for a Hb of 12 g/dl vs. a Hb of 15 g/dl was 1.8 (95% confidence interval 1.2-2.5). Previously established factors, including gender, T category, subglottic extension, as well as tumor bulk, were also prognostically important for local control.

CONCLUSIONS

This analysis, in a large number of similarly treated patients, indicates that pretreatment Hb is an independent prognostic factor for local control in patients with T1/T2 carcinoma of the glottis treated with RT. The underlying biology of this observation needs to be explored, and using this information, it may be possible to develop strategies to improve treatment outcome.

Vascular density in human melanoma xenografts: relationship to angiogenesis, perfusion and necrosis

Studies of interrelationships between physiological parameters of tumours are sparse. The possibility that vascular density might be related to the rate of angiogenesis, the rate of perfusion and/or the development of necrosis was examined in the work reported here. Xenografted tumours of four human melanoma cell lines (A-07, D-12, R-18 and U-25) grown orthotopically in BALB/c nu/nu mice were included in the study. Vascular density and fraction of necrotic tissue were determined by stereological analysis of histological sections. The rate of angiogenesis was measured by using the intradermal angiogenesis assay. The rate of perfusion was studied by using the 86Rb uptake method. A-07 showed a higher vascular density, a higher rate of angiogenesis and a higher rate of perfusion than the other lines. D-12, R-18 and U-25, which differed significantly in the rate of angiogenesis, showed similar vascular densities and similar perfusion rates. Consequently, vascular density is not a sensitive measure of the rate of angiogenesis in the melanoma lines studied here, but might adequately reflect the perfusion rate. Significant necrotic regions developed in D-12 and U-25, but not in A-07 and R-18, presumably because large-diameter vessels, possibly arteriovenous shunts, occurred more frequently in D-12 and U-25 than in A-07 and R-18.

Oxygen tension and vascular density in human cervix carcinoma

Hypoxia-induced radiation resistance has been proposed to be a consequence of low vascular density in tumours. The purpose of the study reported here was to investigate possible relationships between pretreatment oxygen tension (pO2) and vascular density in patients with cervix carcinoma. Tumour pO2 was measured by the use of polarographic needle electrodes. Biopsies were taken from the electrode tracks and vascular density and tissue composition, i.e. volume fraction of carcinoma tissue, stroma and necrosis, were determined by stereological analysis. The vascular density of individual biopsies was related to the median pO2 of the corresponding electrode track. Tumour regions with vascular density below 24 mm mm(-3) always showed low pO2, whereas tumour areas with vascular density above 24 mm mm(-3) could show a high or a low pO2. This indicates the existence of a threshold value of about 24 mm mm(-3) for vascular density in cervix carcinoma; a vascular density above this value is probably needed before high pO2 can occur. Low vascular density might, therefore, be a useful predictor of hypoxia-induced radiation resistance in cervix carcinoma. High vascular density, on the other hand, can probably not be used to exclude radiation resistance. The differences in pO2 among tumour regions with high vascular density were not a consequence of differences in the amount of necrosis or stroma or in the haemoglobin concentration in peripheral blood of the patients. Model calculations indicated that these differences in pO2 could be explained by differences in the oxygen delivery alone and by differences in the oxygen consumption rate alone.

Apoptosis, energy metabolism, and fraction of radiobiologically hypoxic cells: a study of human melanoma multicellular spheroids

The magnitude of the fraction of radiobiologically hypoxic cells in tumours is generally believed to reflect the efficiency of the vascular network. Theoretical studies have suggested that the hypoxic fraction might also be influenced by biological properties of the tumour cells. Quantitative experimental results of cell energy metabolism, hypoxia- induced apoptosis, and radiobiological hypoxia are reported here. Human melanoma multicellular spheroids (BEX-c and WIX-c) were used as tumour models to avoid confounding effects of the vascular network. Radiobiological studies showed that the fractions of hypoxic cells in 1000-microM spheroids were 32 +/- 12% (BEX-c) and 2.5 +/- 1.1% (WIX-c). The spheroid hypoxic volume fractions (28 +/- 6% (BEX-c) and 1.4 +/- 7% (WIX-c)), calculated from the rate of oxygen consumption per cell, the cell packing density, and the thickness of the viable rim, were similar to the fractions of radiobiologically hypoxic cells. Large differences between tumours in fraction of hypoxic cells are therefore not necessarily a result of differences in the efficiency of the vascular network. Studies of monolayer cell cultures, performed to identify the biological properties of the BEX-c and WIX-c cells leading to this large difference in fraction of hypoxic cells, gave the following results: (1) WIX-c showed lower cell surviving fractions after exposure to hypoxia than BEX-c, (2) WIX-c showed higher glucose uptake and lactate release rates than BEX-c both under aerobic and hypoxic conditions, and (3) hypoxia induced apoptosis in WIX-c but not in BEX-c. These observations suggested that the difference between BEX-c and WIX-c spheroids in fraction of hypoxic cells resulted partly from differences in cell energy metabolism and partly from a difference in capacity to retain viability under hypoxic stress. The induction of apoptosis by hypoxia was identified as a phenomenon which has an important influence on the magnitude of the fraction of radiobiologically hypoxic cells in multicellular spheroids.

A pial window model for the intracranial study of human glioma microvascular function

A new model for human brain tumor uses the intracranial placement of tumor xenografts under transparent glass cranial windows in nude rats, which require no immunosuppression for tumor engraftment. Adult male nude rats underwent implantation of human anaplastic astrocytomas (D-54 MG in 10 rats, D-317 MG in 11 rats). The tumors were placed on the pial surface of the left cerebral hemisphere under a glass cranial window overlying the cranium. Six control animals underwent cranial window placement alone. Tumor volumes were estimated from direct measurements of tumor dimensions, revealing a mean doubling time of 1.58 days for the D-54 MG tumors and 2.62 days for the D-317 MG tumors. When tumor volume estimates reached 35 mm3, photomicrographs revealed tumor vasculature in each tumor cell line that was distinct from both the other xenograft and the normal brain parenchyma. Qualitative differences in vascular appearance were supported by length/density coefficient calculations in each study group, with D-317 MG demonstrating the highest vascular density. Vessel caliber tended to be smaller in D-54 MG tumors than in D-317 MG tumors. Laser-Doppler measurements of local blood flow in tumors and normal parenchyma revealed significantly lower blood flow in both tumor cell lines than in control brain. Evaluation of leukocyte/endothelial cell interactions indicated more leukocyte rolling in D-54 MG tumors than in D-317 MG tumors; no evidence of this cell interaction was found in normal pial vasculature. This model allows direct serial inspection of human brain tumor growth and vascular function in an experimental animal and could be used to study tumor vascular and inflammatory responses to a variety of therapeutic manipulations.

Are direct measures of tumor oxygenation reflective of changes in tumor radiosensitivity following oxygen manipulation?

The present study investigates the correlation between tumor oxygen availability and radiosensitivity following oxygen manipulation. Previous work has shown that tumors may contain both diffusion- and perfusion-limited hypoxic cells. Recently, the combination of nicotinamide (NIC) administration plus carbogen breathing has been proposed as a means of targeting both hypoxic cell subpopulations. Intravascular HbO2 saturations were measured for KHT murine sarcomas following either NIC, carbogen breathing, or the combination, and compared with determinations of tumor cell survival under matched conditions. The percentage of vessels > or = 25% HbO2 increased significantly for both the carbogen and NIC-carbogen combination, while remaining unchanged from controls following NIC. These findings contrast with the survival data, where all treatments showed identical cell survival. A possible explanation is that different proportions of clonogenic versus nonclonogenic cells may be oxygenated by the alternative treatments. Thus direct determinations of alterations in tumor oxygenation may not reflect corresponding changes in radiosensitivity.

Pretreatment oxygenation profiles of human soft tissue sarcomas

PURPOSE

Tumor oxygenation is thought to influence the radiocurability of many malignancies. Advances in polarographic electrode technology have facilitated the in situ measurement of human tumor pO2. The optimal method of defining a "hypoxic" tumor is not known. Characterization of intra-tumor and intertumor pO2 heterogeneity could help with this process. This study was performed to evaluate pretreatment tumor oxygenation status and pO2 heterogeneity in patients with soft tissue sarcoma.

METHODS AND MATERIALS

Nine patients with soft tissue sarcomas underwent pretreatment pO2 measurements with the Eppendorf pO2 histograph. Two grossly distinct anatomic sites within each tumor were measured in all but one patient; these were localized under computerized tomography guidance to ensure that all measurements were obtained from tumor tissue. Multiple probe tracks were studied at each site. Measurements were performed in resting, awake patients.

RESULTS

A total of 1588 pO2 readings was obtained (mean = 176/patient). Measurement path lengths ranged from 22-36 mm. The average hypoxic fraction (pO2 < 5 mm Hg) was 29% (range 0-76%). Arterial pO2 was positively correlated with mean and median tumor pO2. Tumor hypoxic fraction increased with increasing tumor volume. Linear pO2 profiles and frequency histograms provided similar estimates of the extent of hypoxia in individual tumors. Marked variation in oxygenation existed both within and between individual tumors. The intertumor variation was greater than the intratumor variation.

CONCLUSION

Radiobiologic hypoxia exists in human soft tissue sarcomas. The pO2 variation within individual tumors is less than the variation between tumors. Further study is necessary to identify the best parameter for defining tumor hypoxia and to discern the relationship between tumor pO2 and treatment outcome.

Noninvasive measurement of microvascular and interstitial oxygen profiles in a human tumor in SCID mice

Simultaneous measurements of intravascular and interstitial oxygen partial pressure (PO2) in any tissue have not previously been reported, despite the importance of oxygen in health and in disease. This is due to the limitations of current techniques, both invasive and noninvasive. We have optically measured microscopic profiles of PO2 with high spatial resolution in subcutaneous tissue and transplanted tumors in mice by combining an oxygen-dependent phosphorescence quenching method and a transparent tissue preparation. The strengths of our approach include the ability to follow PO2 in the same location for several weeks and to relate these measurements to local blood flow and vascular architecture. Our results show that (i) PO2 values in blood vessels in well-vascularized regions of a human colon adenocarcinoma xenograft are comparable to those in surrounding arterioles and venules, (ii) carbogen (95% O2/5% CO2) breathing increases microvascular PO2 in tumors, and (iii) in unanesthetized and anesthetized mice PO2 drops to hypoxic values at < 200 microns from isolated vessels but drops by < 5 mmHg (1 mmHg = 133 Pa) in highly vascularized tumor regions. Our method should permit noninvasive evaluations of oxygen-modifying agents and offer further mechanistic information about tumor pathophysiology in tissue preparations where the surface of the tissue can be observed.

Vascular morphometry of KHT and RIF-1 murine sarcomas

Although tumor oxygenation and vascular structure have been studied extensively, previous work has most often been qualitative in nature. To clarify underlying physiological mechanisms, a more quantitative approach is needed. The current work considers two murine tumor lines of differing radiobiological hypoxic fraction (HF), the RIF-1 and the KHT fibrosarcomas. Following intravascular injection of India ink, histological sections were prepared and quantitated in terms of anatomical blood vessel-tumor cell distance distributions and vessel diameters. Vessel diameters increased with increasing tumor volume for RIF-1 tumors, while not changing significantly for the KHT. The fraction of the tumor within a given distance of the nearest blood vessel, varied as a function of: (i) tumor line, (ii) distance from tumor surface, and (iii) tumor volume. For small-volume tumors, intertumor differences in vessel-tumor cell distances correlated with differences in radiobiological HF, while for large-volume tumors, vessel-tumor cell differences were not significantly different between tumor lines. Combining current findings with previously determined intravascular oxyhemoglobin distributions in the same two tumor lines, it was apparent that not only is a substantial portion of the tumor volume beyond the expected oxygen diffusion limits of blood vessels, but, in addition, a relatively low percentage of these vessels is capable of supplying oxygen.

Analysis of oxygen transport to tumor tissue by microvascular networks

We present theoretical simulations of oxygen delivery to tumor tissues by networks of microvessels, based on in vivo observations of vascular geometry and blood flow in the tumor microcirculation. The aim of these studies is to investigate the impact of vascular geometry on the occurrence of tissue hypoxia. The observations were made in the tissue (thickness 200 microns) contained between two glass plates in a dorsal skin flap preparation in the rat. Mammary adenocarcinomas (R3230 AC) were introduced and allowed to grow, and networks of microvessels in the tumors were mapped, providing data on length, geometric orientation, diameter and blood velocity in each segment. Based on these data, simulations were made of a 1 mm x 1 mm region containing five unbranched vascular segments and a 0.25 mm x 0.35 mm region containing 22 segments. Generally, vessels were assumed to lie in the plane midway between the glass plates, at 100 microns depth. Flow rates in the vessels were based on measured velocities and diameters. The assumed rate of oxygen consumption in the tissue was varied over a range of values. Using a Green's function method, partial pressure of oxygen (PO2) was computed at each point in the tissue region. As oxygen consumption is increased, tissue PO2 falls, with hypoxia first appearing at points relatively distant from the nearest blood vessel. The width of the well-oxygenated region is comparable to that predicted by simpler analyses. Cumulative frequency distributions of tissue PO2 were compared with predictions of a Krogh-type model with the same vascular densities, and it was found that the latter approach, which assumes a uniform spacing of vessels, may underestimate the extent of the hypoxic tissue. Our estimates of the maximum consumption rate that can be sustained without tissue hypoxia were substantially lower than those obtained from the Krogh-type model. We conclude that the heterogeneous structure of tumor microcirculation can have a substantial effect on the occurrence of hypoxic micro-regions.

Should tumors be clamped in radiobiological fractionation experiments?

In radiobiological fractionation experiments tumors are often clamped during irradiation. This is done not only to facilitate the interpretation of the data by eliminating the influence of reoxygenation but also to avoid uncontrolled changes in the hypoxic fraction that are caused by anesthesia or stress from physical restraint. In this study it is shown that clamping of tumors during irradiation also affects repair, repopulation, and redistribution. From these results it is concluded that clamping of tumors during fractionated irradiation treatment does not appear to be an adequate measure to elucidate the mechanisms that determine tumor response to radiotherapy. Even some of the fundamental concepts of tumor radiobiology might contain some uncertainties, since they are often based on data resulting from clamped tumors.

Morphologic and hemodynamic comparison of tumor and healing normal tissue microvasculature

The purpose of this study was to compare microvascular morphometric and hemodynamic characteristics of a tumor and granulating normal tissue to develop quantitative data that could be used to predict microvascular characteristics which would be most likely associated with hypoxia. The dorsal flap window chamber of the Fisher 344 rat was used to visualize the microvasculature of 10 granulating and 12 tumor (R3230 AC adenocarcinoma) tissues at 2 weeks following surgical implantation of the chamber. Morphometric measurements were made from photomontages and video techniques were used to assess red cell velocities in individual vessels. The percent vascular volume of both tissues was close to 20%, but significant differences were noted in other morphometric and hemodynamic measurements. Individual vessel dimensions (length and diameter) in tumors averaged twice as large as those in granulating tissues. Furthermore, red cell velocities were twice as high in tumors as in granulating tissues. In addition to these large differences in average values, there was significant heterogeneity in tumor microvascular morphometry, indicating spatial nonuniformity compared with the granulating tissue. Approximations of vessel spacing, indicated an average of 257 and 118 microns in tumors and granulating tissues, respectively. Vessel densities were four times greater in granulating tissues than in tumor tissues. These results indicated that intervessel distances were more likely to result in hypoxia in tumors, especially considering the wide variability in that tissue. Analysis of flow branching patterns showed that vascular shunts occurred frequently in vessels ranging from 10 to 90 microns in diameter. The results of this study indicate, in this tumor model, that conditions such as low vascular density, vascular shunts, excessive vascular length and/or low red cell velocity exist to a greater extent than the granulating tissue control. These conditions are likely to be conductive to the development of hypoxia.