The detection and measurement of hypoxic cells in solid tumors

The presence of viable hypoxic cells in human cancers has concerned oncologists for years. Cells in tissues that are deficient in oxygen are relatively resistant to radiation inactivation and may not be accessible to some systemic chemotherapy. The premise that hypoxic tumor cells do, indeed, control the radiocurability of some cancers is supported by some clinical evidence. The presence of hypoxic regions within tumors can be directly and indirectly inferred from invasive procedures such as oxygen electrode techniques and histologic study, respectively, but such information does not significantly contribute to current prescriptions given by oncologists for tumor treatment. Novel procedures (some of which are noninvasive) for detecting hypoxic regions within solid tumors have been proposed and are based upon two recent developments: (1) the discovery that some radiosensitizing drugs become selectively bound by metabolism to the molecules of viable hypoxic cells, and (2) the growing availability of new imaging procedures based upon positron-emission tomography, single-photon emission tomography, and nuclear magnetic resonance spectroscopy. Preliminary research results from these novel procedures are reviewed, and the potential clinical impact of each is discussed.