Prognostic value of tumor oxygenation in 397 head and neck tumors after primary radiation therapy. An international multi-center study

Marianne Nordsmark, Søren M. Bentzen, Volker Rudat, David Brizel, Eric Lartigau, Peter Stadler, Axel Becker, Markus Adam, Michael Molls, Juergen Dunst, David J. Terris, Jens Overgaard

Research output: Contribution to journalArticle

654 Citations (Scopus)

Abstract

Purpose: To analyze the relationship between pre-treatment measurements of tumor oxygen tension (pO2) and survival in advanced head and neck cancer. Patients and methods: Eppendorf pO2 measurements in 397 patients from seven centers were analyzed using the fraction of pO2 values ≤2.5 mmHg (HP2.5), ≤5 mmHg (HP5) and median tumor pO2 (mmHg) as descriptors. All patients had intended curative radiation therapy alone or as pre- or post-operative radiotherapy or radio-chemotherapy according to the practice at each center. Results: The degree of hypoxia varied between tumors with an overall median tumor pO2=9 mmHg (range 0-62 mmHg), a median HP2.5=19% (range 0-97%) and HP 5=38%, (range 0-100%). By quadratic regression median tumor pO 2 correlated with Hb (2P=0.026, n=357), while HP2.5 or HP5 did not. HP2.5 above the population median was the only parameter that associated with poor overall survival (Kaplan Meier analysis, P=0.006). In a multivariate Cox Proportional Hazards analysis, stratified according to institution HP2.5 was by far the most statistically significant factor in explaining the variability in survival. After adjusting for HP2.5, clinical stage, radiation dose and surgery hemoglobin concentration was not significant in the model. The prognostic model shows that the 5-year survival is almost constant for HP2.5 values in the range from 0 to 20%, whereas the 5-year survival approaches 0% in the most hypoxic tumors. Conclusion: This study provides evidence that tumor hypoxia is associated with a poor prognosis in patients with advanced head and neck cancer.

Original languageEnglish (US)
Pages (from-to)18-24
Number of pages7
JournalRadiotherapy and Oncology
Volume77
Issue number1
DOIs
StatePublished - Oct 1 2005

Fingerprint

Neck
Radiotherapy
Head
Survival
Neoplasms
Head and Neck Neoplasms
Kaplan-Meier Estimate
Radio
Hemoglobins
Radiation
Oxygen
Drug Therapy
Population
Therapeutics

Keywords

  • Head and neck cancer
  • Hemoglobin
  • Hypoxia
  • Polarographic oxygen electrode

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Prognostic value of tumor oxygenation in 397 head and neck tumors after primary radiation therapy. An international multi-center study. / Nordsmark, Marianne; Bentzen, Søren M.; Rudat, Volker; Brizel, David; Lartigau, Eric; Stadler, Peter; Becker, Axel; Adam, Markus; Molls, Michael; Dunst, Juergen; Terris, David J.; Overgaard, Jens.

In: Radiotherapy and Oncology, Vol. 77, No. 1, 01.10.2005, p. 18-24.

Research output: Contribution to journalArticle

Nordsmark, M, Bentzen, SM, Rudat, V, Brizel, D, Lartigau, E, Stadler, P, Becker, A, Adam, M, Molls, M, Dunst, J, Terris, DJ & Overgaard, J 2005, 'Prognostic value of tumor oxygenation in 397 head and neck tumors after primary radiation therapy. An international multi-center study', Radiotherapy and Oncology, vol. 77, no. 1, pp. 18-24. https://doi.org/10.1016/j.radonc.2005.06.038
Nordsmark, Marianne ; Bentzen, Søren M. ; Rudat, Volker ; Brizel, David ; Lartigau, Eric ; Stadler, Peter ; Becker, Axel ; Adam, Markus ; Molls, Michael ; Dunst, Juergen ; Terris, David J. ; Overgaard, Jens. / Prognostic value of tumor oxygenation in 397 head and neck tumors after primary radiation therapy. An international multi-center study. In: Radiotherapy and Oncology. 2005 ; Vol. 77, No. 1. pp. 18-24.
@article{6ff97bf27e1c4bc0bd2c190b8ae34a05,
title = "Prognostic value of tumor oxygenation in 397 head and neck tumors after primary radiation therapy. An international multi-center study",
abstract = "Purpose: To analyze the relationship between pre-treatment measurements of tumor oxygen tension (pO2) and survival in advanced head and neck cancer. Patients and methods: Eppendorf pO2 measurements in 397 patients from seven centers were analyzed using the fraction of pO2 values ≤2.5 mmHg (HP2.5), ≤5 mmHg (HP5) and median tumor pO2 (mmHg) as descriptors. All patients had intended curative radiation therapy alone or as pre- or post-operative radiotherapy or radio-chemotherapy according to the practice at each center. Results: The degree of hypoxia varied between tumors with an overall median tumor pO2=9 mmHg (range 0-62 mmHg), a median HP2.5=19{\%} (range 0-97{\%}) and HP 5=38{\%}, (range 0-100{\%}). By quadratic regression median tumor pO 2 correlated with Hb (2P=0.026, n=357), while HP2.5 or HP5 did not. HP2.5 above the population median was the only parameter that associated with poor overall survival (Kaplan Meier analysis, P=0.006). In a multivariate Cox Proportional Hazards analysis, stratified according to institution HP2.5 was by far the most statistically significant factor in explaining the variability in survival. After adjusting for HP2.5, clinical stage, radiation dose and surgery hemoglobin concentration was not significant in the model. The prognostic model shows that the 5-year survival is almost constant for HP2.5 values in the range from 0 to 20{\%}, whereas the 5-year survival approaches 0{\%} in the most hypoxic tumors. Conclusion: This study provides evidence that tumor hypoxia is associated with a poor prognosis in patients with advanced head and neck cancer.",
keywords = "Head and neck cancer, Hemoglobin, Hypoxia, Polarographic oxygen electrode",
author = "Marianne Nordsmark and Bentzen, {S{\o}ren M.} and Volker Rudat and David Brizel and Eric Lartigau and Peter Stadler and Axel Becker and Markus Adam and Michael Molls and Juergen Dunst and Terris, {David J.} and Jens Overgaard",
year = "2005",
month = "10",
day = "1",
doi = "10.1016/j.radonc.2005.06.038",
language = "English (US)",
volume = "77",
pages = "18--24",
journal = "Radiotherapy and Oncology",
issn = "0167-8140",
publisher = "Elsevier Ireland Ltd",
number = "1",

}

TY - JOUR

T1 - Prognostic value of tumor oxygenation in 397 head and neck tumors after primary radiation therapy. An international multi-center study

AU - Nordsmark, Marianne

AU - Bentzen, Søren M.

AU - Rudat, Volker

AU - Brizel, David

AU - Lartigau, Eric

AU - Stadler, Peter

AU - Becker, Axel

AU - Adam, Markus

AU - Molls, Michael

AU - Dunst, Juergen

AU - Terris, David J.

AU - Overgaard, Jens

PY - 2005/10/1

Y1 - 2005/10/1

N2 - Purpose: To analyze the relationship between pre-treatment measurements of tumor oxygen tension (pO2) and survival in advanced head and neck cancer. Patients and methods: Eppendorf pO2 measurements in 397 patients from seven centers were analyzed using the fraction of pO2 values ≤2.5 mmHg (HP2.5), ≤5 mmHg (HP5) and median tumor pO2 (mmHg) as descriptors. All patients had intended curative radiation therapy alone or as pre- or post-operative radiotherapy or radio-chemotherapy according to the practice at each center. Results: The degree of hypoxia varied between tumors with an overall median tumor pO2=9 mmHg (range 0-62 mmHg), a median HP2.5=19% (range 0-97%) and HP 5=38%, (range 0-100%). By quadratic regression median tumor pO 2 correlated with Hb (2P=0.026, n=357), while HP2.5 or HP5 did not. HP2.5 above the population median was the only parameter that associated with poor overall survival (Kaplan Meier analysis, P=0.006). In a multivariate Cox Proportional Hazards analysis, stratified according to institution HP2.5 was by far the most statistically significant factor in explaining the variability in survival. After adjusting for HP2.5, clinical stage, radiation dose and surgery hemoglobin concentration was not significant in the model. The prognostic model shows that the 5-year survival is almost constant for HP2.5 values in the range from 0 to 20%, whereas the 5-year survival approaches 0% in the most hypoxic tumors. Conclusion: This study provides evidence that tumor hypoxia is associated with a poor prognosis in patients with advanced head and neck cancer.

AB - Purpose: To analyze the relationship between pre-treatment measurements of tumor oxygen tension (pO2) and survival in advanced head and neck cancer. Patients and methods: Eppendorf pO2 measurements in 397 patients from seven centers were analyzed using the fraction of pO2 values ≤2.5 mmHg (HP2.5), ≤5 mmHg (HP5) and median tumor pO2 (mmHg) as descriptors. All patients had intended curative radiation therapy alone or as pre- or post-operative radiotherapy or radio-chemotherapy according to the practice at each center. Results: The degree of hypoxia varied between tumors with an overall median tumor pO2=9 mmHg (range 0-62 mmHg), a median HP2.5=19% (range 0-97%) and HP 5=38%, (range 0-100%). By quadratic regression median tumor pO 2 correlated with Hb (2P=0.026, n=357), while HP2.5 or HP5 did not. HP2.5 above the population median was the only parameter that associated with poor overall survival (Kaplan Meier analysis, P=0.006). In a multivariate Cox Proportional Hazards analysis, stratified according to institution HP2.5 was by far the most statistically significant factor in explaining the variability in survival. After adjusting for HP2.5, clinical stage, radiation dose and surgery hemoglobin concentration was not significant in the model. The prognostic model shows that the 5-year survival is almost constant for HP2.5 values in the range from 0 to 20%, whereas the 5-year survival approaches 0% in the most hypoxic tumors. Conclusion: This study provides evidence that tumor hypoxia is associated with a poor prognosis in patients with advanced head and neck cancer.

KW - Head and neck cancer

KW - Hemoglobin

KW - Hypoxia

KW - Polarographic oxygen electrode

UR - http://www.scopus.com/inward/record.url?scp=26444466467&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=26444466467&partnerID=8YFLogxK

U2 - 10.1016/j.radonc.2005.06.038

DO - 10.1016/j.radonc.2005.06.038

M3 - Article

C2 - 16098619

AN - SCOPUS:26444466467

VL - 77

SP - 18

EP - 24

JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

SN - 0167-8140

IS - 1

ER -