Oxygen distribution in squamous cell carcinoma metastases and its relationship to outcome of radiation therapy

Oxygen distribution was measured in 31 fixed lymph node metastases (mean diameter 4.4 cm +/- 0.8 cm) from squamous cell carcinoma of the head and neck by passing a needle electrode through each tumor under CT guidance. Thirteen tumors had uniform oxygen distribution with all measurements under 10 mm Hg. Six tumors had uniform oxygen distribution with all measurements above 10 mm Hg, and twelve tumors had variable oxygen distribution with measurements higher in the periphery than in the center. Response to radiation therapy was judged by changes in tumor volume 90 days following completion of therapy compared to pre-therapy volume. Eighteen tumors were considered complete responders (CR); eleven, non-responders (NR); two, partial responders (PR). No statistically significant difference in radiation dose or tumor size was seen in the PR and CR groups. Mean pO2 was 20.6 (+/- 4.4) mm Hg in the CR group and 4.7 (+/- 3.0) mm Hg in the NR group (p less than 0.001). Normalized pO2 content defined as the total tumor oxygen content normalized by dividing by the volume was 37.4 (+/- 8.2) mm Hg in the CR group and 8.2 (+/- 5.1) mm Hg in the NR group (p less than 0.001). The volume and oxygen levels of each tumor were tabulated and analyzed. Twelve tumors had greater than 26% of their volume containing a pO2 less than 8 mm Hg. Eleven of these were NR and one PR. Nineteen tumors had less than 26% of their volume containing a pO2 less than 8 mm Hg. Eighteen were CR and one PR (p less than 0.001). These data suggest that oxygen plays a significant role in human tumor response to radiation therapy. Oxygen measurements appear to allow separation of subgroups of patients with a poor prognosis who would most benefit from maneuvers to circumvent the hypoxic effect.