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Predictive value of hypoxia in advanced head and neck cancer after treatment with hyperfractionated radio-chemotherapy and hypoxia modification

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Abstract

Purpose

Hypoxia has predictive value in head and neck cancer (HNC). It has been well described, albeit in a small number of clinical Centres. The aim of this study was to describe our experience using the polarographic probe technique to assess the predictive value of tumour oxygenation in patients with advanced HNC treated with hyperfractionated radio-chemotherapy. Hypoxia modification was induced using percutaneous spinal cord stimulation (SCS).

Methods/patients

Male patients (n = 12; stage IVb n = 8; IVa n = 4; mean age 58: range 46–70 years) with advanced HNC were evaluated. Planned therapy was hyperfractionated-radiotherapy, oral tegafur (precursor of 5-fluorouracil) and hypoxia modification using SCS. Pre-treatment analyses included: haemoglobin levels and tumour oxygenation (using the Eppendorf polarographic probe device). Oxygenation was expressed as median-pO2 (in mmHg) and hypoxia as the percentage of pO2 values ≤5 mmHg (HP5) and ≤2.5 mmHg (HP2.5).

Results

Lower haemoglobin levels were directly correlated with median pO2 (p = 0.017) and inversely correlated with HP5 (p = 0.020) and more advanced stages (IVb vs. IVa; p = 0.028). Patients who subsequently developed systemic metastasis had tumours that were more hypoxic, with lower median pO2 (p = 0.036) and higher HP5 (p = 0.036). The subgroup of patients with HP2.5 above the median (the most hypoxic tumours) had lower loco-regional control (p = 0.027), cause-specific survival (p = 0.008), and overall survival (p = 0.008).

Conclusions

Higher tumour hypoxia showed predictive value in HNC in our study, and was significantly associated with lower overall survival, cause-specific survival, and loco-regional control. Tumour hypoxia determination could be used to select patients who would most benefit by hypoxia modification during chemo-radiotherapy of HNC.

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Acknowledgments

We thank the nursing staff of the Functional and Stereotactic Neurosurgery Unit and Radiation Oncology Department for their dedication to patient care and management. Editorial assistance was by Dr. Peter R. Turner of Tscimed.com.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Dr. Negrin University Hospital, 35010, Las Palmas, Canary Islands, Spain

    B. Clavo, M. Lloret & D. Rey-Baltar

  2. Research Unit, Dr. Negrin University Hospital, Las Palmas, Spain

    B. Clavo, D. Fiuza, P. Llontop & N. Santana-Rodríguez

  3. ICIC (Canary Islands Institute for Cancer Research), Las Palmas, Spain

    B. Clavo & M. Lloret

  4. GICOR (Spanish Group of Clinical Research in Radiation Oncology), Madrid, Spain

    B. Clavo

  5. Functional and Stereotactic Neurosurgery Unit, Dr. Negrin University Hospital, Las Palmas, Spain

    F. Robaina

  6. Department of Radiation Oncology, Hospital Universitario Doce de Octubre, Madrid, Spain

    A. Ruiz

  7. Department of Radiation Oncology, Clínica Marly, Bogotá, Colombia

    A. Riveros

  8. Department of Otolaryngology, Dr. Negrin University Hospital, Las Palmas, Spain

    J. Rivero & F. Castañeda

  9. Maxillofacial Surgery, Dr. Negrín University Hospital, Las Palmas, Spain

    S. Quintero

  10. Department of Thoracic Surgery, Mount Sinai Health System, New York, USA

    N. Santana-Rodríguez

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  1. B. Clavo
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  2. F. Robaina
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  3. D. Fiuza
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  5. M. Lloret
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  9. J. Rivero
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  10. F. Castañeda
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  12. N. Santana-Rodríguez
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Corresponding author

Correspondence to B. Clavo.

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Funding

The Eppendorf device was purchased with a grant (FUNCIS 98/31) from the Health and Research Foundation of the Autonomous Government of the Canary Islands (Spain).

Conflict of interest

Currently, Dr B. Clavo and Dr F. Robaina are in receipt of financial support from Medtronic Ibérica (Madrid, Spain) for an ongoing clinical trial involving hypoxia in brain tumours (also supported by ISCIII PI 12/02940, ClinicalTrials.gov: NCT01868906).

Informed consent

The study was fully explained to the patient before written consent was obtained.

Ethical approval

The study had the full approval of the Institutional Ethical Committee, All clinical methods were in accordance with the 1964 Helsinki declaration, and its later amendments.

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Clavo, B., Robaina, F., Fiuza, D. et al. Predictive value of hypoxia in advanced head and neck cancer after treatment with hyperfractionated radio-chemotherapy and hypoxia modification. Clin Transl Oncol 19, 419–424 (2017). https://doi.org/10.1007/s12094-016-1541-x

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  • DOI: https://doi.org/10.1007/s12094-016-1541-x

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