Drug delivery to tumors. A problem requiring microscopic resolution

One factor in the effectiveness of chemotherapy for both primary tumors and their metastases is the delivery of the drug to the cancer cells within the tumor. The uptake of Adriamycin, assayed in 8 cu mm samples from primary tumors, lung metastases and "normal" lung tissue (unaffected by the metastases) in mice, showed wide variations between different tumors, between primary tumors and their metastases and between different metastases. The heterogeneity of uptake was greater in tumors than in normal lung tissues, whose uptake was in the range of the metastases, i.e., higher than in the tumor itself. Studies of Adriamycin uptake within individual tumors showed a wide range of values; this variability was statistically significantly increased as compared with the variation in normal lung tissues. Since the lower levels found in some tumor areas were below the cytotoxic level, those areas may represent "drug-resistant" cells from which tumor recurrence could ensue. In a three-dimensional reconstruction, the areas of lowest uptake were found at both peripheral and internal regions, a finding not in accord with the concentric zonal concentration expected on the basis of considerations of tumor vascularity. It is suggested that the problem of drug delivery to tumors needs further study at the microscopic level and that automated microscopic image analysis and three-dimensional reconstructions of serial sections could greatly extend the macroscopic findings of this study.