Abstract
For many years, the identification of tumor hypoxia, its systematic characterization and the assessment of its clinical relevance were not possible due to the lack of methods suitable for the routine measurement of intratumoral oxygen tensions in patients. In the late 1980s, a novel and clinically applicable standardized procedure was established enabling the determination of tumor oxygenation in accessible primary tumors, local recurrences, and metastatic lesions in patients using a computerized polarographic needle electrode system (Höckel et al. 1991; Vaupel et al. 1991).Within a relatively short period of time, the significance of tumor oxygenation for therapy outcome became evident in numerous experimental and clinical studies (for a review see Vaupel and Kelleher 1999).
Supported by a grant from the Deutsche Krebshilfe (106758).
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Airley R, Loncaster J, Davidson S, Bromley M, Roberts S, Patterson A, Hunter R, Stratford I, West C (2001) Glucose transporter Glut-1 expression correlates with tumor hypoxia and predicts metastasis-free survival in advanced carcinoma of the cervix. Clin Cancer Res 7: 928–934
Anderson CJ, Hoare SF, Ashcroft M, Bilsland AE, Keith WN (2006) Hypoxic regulation of telomerase gene expression by transcriptional and post-transcriptional mechanisms. Oncogene 25: 61–69
Ausserer WA, Bourrat-Floeck B, Green CJ, Laderoute KR, Sutherland RM (1994) Regulation of c-jun expression during hypoxic and low-glucose stress. Mol Cell Biol 14: 5032–5042
Awwad HK, Naggar M, Mocktar N, Barsoum M (1986) Intercapillary distance measurement as an indicator of hypoxia in carcinoma of the cervix uteri. Int J Radiat Oncol Biol Phys 12: 1329–1333
Birner P, Schindl M, Obermair A, Plank C, Breitenecker G, Oberhuber G (2000) Overexpression of hypoxia-inducible factor 1a is a marker for an unfavorable prognosis in early-stage invasive cervical cancer. Cancer Res 60: 4693–4696
Brizel DM, Scully SP, Harrelson JM, Layfield LJ, Bean JM, Prosnitz LR, Dewhirst MW (1996) Tumor oxygenation predicts for the likelihood of distant metastases in human soft tissue sarcoma. Cancer Res 56: 941–943
Brizel DM, Sibley GS, Prosnitz LR, Scher RL, Dewhirst MW (1997) Tumor hypoxia adversely affects the prognosis of carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 38: 285–289
Brown JM, Giaccia AJ (1998) The unique physiology of solid tumors: opportunities (and problems) for cancer therapy. Cancer Res 58: 1408–1416
Bush RS (1986) The significance of anemia in clinical radiation therapy. Int J Radiat Oncol Biol Phys 12: 2047–2050
Chabner B, Allegra CJ, Curt GA, Calabresi P (1996) Antineoplastic agents. In: Goodman & Gilman’s The pharmacological basis of therapeutics, 9th edn. McGraw-Hill, New York, pp 1233–1287
Chaplin DJ, Horsman MR, Trotter MJ, Siemann DW (2000) Therapeutic significance of microenvironmental factors. In: Molls M, Vaupel P (eds) Blood perfusion and microenvironment of human tumors. Implications for clinical radiooncology. Springer, Berlin Heidelberg New York, pp 133–143
Chapman JD, Stobbe CC, Arnfield MR, Santus R, Lee L, McPhee MS (1991) Oxygen dependency of tumor cell killing in vitro by light-activated Photofrin II. Radiat Res 126: 73–79
Cheng KC, Loeb LA (1993) Genomic instability and tumor progression: mechanistic considerations. Adv Cancer Res 60: 121–156
Collingridge DR, Piepmeier JM, Rockwell S, Knisely JPS (1999) Polarographic measurements of oxygen tension in human glioma and surrounding peritumoural brain tissue. Radiother Oncol 53: 127–131
Comerford KM, Wallace TJ, Karhausen J, Louis NA, Montalto MC, Colgan SP (2002) Hypoxia-inducible factor-1-dependent regulation of the multidrug resistance (MDR1) gene. Cancer Res 62: 3387–3394
Dachs GU, Tozer GM (2000) Hypoxia modulated gene expression: angiogenesis, metastasis and therapeutic exploitation. Eur J Cancer 36: 1649–1660
Dunst J (2004) Low hemoglobin levels: influence on tumor biology and radiotherapy treatment outcome. Eur J Cancer [Suppl] 2: 3–10
Durand RE (1991) Keynote address: The influence of microenvironmental factors on the activity of radiation and drugs. Int J Radiat Oncol Biol Phys 20: 253–258
Durand RE (1994) The influence of microenvironmental factors during cancer therapy. In Vivo 8: 691–702
Erlichman C (1992) Pharmacology of anticancer drugs. In: Tannock IF, Hill RP (eds) The basic science of oncology, 2nd edn. McGraw-Hill, New York, pp 317–337
Evans IC, Bergsjø P (1965) The influence of anemia on the results of radiotherapy in carcinoma of the cervix. Radiology 84: 709–717
Evans SM, Koch CJ (2003) Prognostic significance of tumor oxygenation in humans. Cancer Letters 195: 1–16
Evans SM, Judy KD, Dunphy I, Jenkins WT, Nelson PT, Collins R, Wileyto EP, Jenkins K, Hahn SM, Stevens CW, Judkins AR, Phillips P, Geoerger B, Koch CJ (2004) Comparative measurements of hypoxia in human brain tumors using needle electrodes and EF5 binding. Cancer Res 64: 1886–1892
Freitas I, Baronzio GF (1991) Tumor hypoxia, reoxygenation and oxygenation strategies: possible role in photodynamic therapy. J Photochem Photobiol B: Biol 11: 3–30
Frommhold H, Guttenberger R, Henke M (1998) The impact of blood hemoglobin content on the outcome of radiotherapy. Strahlenther Onkol 174: 31–34
Fyles AW, Milosevic M, Wong R, Kavanagh M-C, Pintilie M, Sun A, Chapman W, Levin W, Manchul L, Keane TJ, Hill RP (1998) Oxygenation predicts radiation response and survival in patients with cervix cancer. Radiother Oncol 48: 149–156
Giaccia AJ (1996) Hypoxic stress proteins: survival of the fittest. Semin Radiat Oncol 6: 46–58
Graeber TG, Osmanian C, Jacks T, Housman DE, Koch CJ, Lowe SW, Giaccia AJ (1996) Hypoxia-mediated selection of cells with diminished apoptotic potential in solid tumours. Nature 379: 88–91
Graeber TG, Peterson JF, Tsai M, Monica K, Fornace AJ, Giaccia AJ (1994) Hypoxia induces accumulation of p53 protein, but activation of a G1-phase checkpoint by low-oxygen conditions is independent of p53 status. Molecular Cell Biol 14: 6264–6277
Grau C, Overgaard J (2000) Significance of hemoglobin concentration for treatment outcome. In: Molls M, Vaupel P (eds) Blood perfusion and microenvironment of human tumors. Implications for clinical radiooncology. Springer, Berlin Heidelberg New York, pp 101–112
Gray LH, Conger AD, Ebert M, Hornsey S, Scott OCA (1953) The concentration of oxygen dissolved in tissues at the time of irradiation as a factor in radiotherapy. Br J Radiol 26: 638–648
Hall EJ, Giaccia A (2006) Radiobiology for the radiologist, 6th edn. Lippincott, Philadelphia
Harrison L, Blackwell K ( 2004) Hypoxia and anemia: Factors in decreased sensitivity to radiation therapy and chemotherapy? Oncologist 9: 31–40
Harrison LB, Chadha M, Hill RJ, Hu K, Shasha D (2002) Impact of tumor hypoxia and anemia on radiation therapy outcomes. Oncologist 7: 492–508Prof. Dr.
Henderson BW, Fingar VH (1987) Relationship of tumor hypoxia and response to photodynamic treatment in an experimental mouse tumor. Cancer Res 47: 3110–3114
Henke M, Momm F, Guttenberger R (1999) Erythropoietin for patients undergoing radiotherapy: The Freiburg experience. In: Vaupel P, Kelleher DK (eds) Tumor hypoxia. Pathophysiology, clinical significance and therapeutical perspectives. Wissenschaftliche Verlagsgesellschaft, Stuttgart, pp 91–97
Henke M, Laszig R, Rübe C, Schäfer U, Haase KD, Schilcher B, Mose S, Beer KT, Burger U, Dougherty C, Frommhold H (2003) Erythropoietin to treat head and neck cancer patients with anaemia undergoing radiotherapy: Randomised, double-blind, placebo-controlled trial. Lancet 362: 1255–1260
Hickman JA, Potten CS, Merritt AJ, Fisher TC (1994) Apoptosis and cancer chemotherapy. Phil Trans R Soc B 345: 319–325
Höckel M, Vaupel P (2001a) Tumor hypoxia: Definitions and current clinical, biological and molecular aspects. J Natl Cancer Inst 93: 266–276
Höckel M, Vaupel P (2001b) Prognostic significance of tissue hypoxia in cervical cancer. CME J Gynecol Oncol 6: 216–225
Höckel M, Knoop C, Schlenger K, Vorndran B, Baussmann E, Mitze M, Knapstein PG, Vaupel P (1993) Intratumoral pO2 predicts survival in advanced cancer of the uterine cervix. Radiother Oncol 26: 45–50
Höckel M, Schlenger K, Aral B, Mitze M, Schäffer U, Vaupel P (1996) Association between tumor hypoxia and malignant progression in advanced cancer of the uterine cervix. Cancer Res 56: 4509–4515
Höckel M, Schlenger K, Höckel S, Aral B, Schäffer U, Vaupel P (1998) Tumor hypoxia in pelvic recurrences of cervical cancer. Int J Cancer 79: 365–369
Höckel M, Schlenger K, Höckel S, Vaupel P (1999) Hypoxic cervical cancers with low apoptotic index are highly aggressive. Cancer Res 59: 4525–4528
Hoeckel M, Schlenger K, Knoop C, Vaupel P (1991) Oxygenation of carcinomas of the uterine cervix: Evaluation of computerized O2 tension measurements. Cancer Res 51: 6098–6102
Kallinowski F, Buhr HJ (1995) Tissue oxygenation of primary, metastatic and xenografted rectal cancers. In: Vaupel P, Kelleher DK, Günderoth M (eds) Tumor oxygenation. Fischer, Stuttgart, pp 205–209
Kelleher DK, Matthiensen U, Thews O, Vaupel P (1996) Blood flow, oxygenation, and bioenergetic status of tumors after erythropoietin treatment in normal and anemic rats. Cancer Res 56: 4728–4734
Kelleher DK, Thews O, Vaupel P (1999) Modulation of tumor oxygenation and radiosensitivity by erythropoietin. In: Vaupel P, Kelleher DK (eds) Tumor hypoxia. Pathophysiology, clinical significance and therapeutic perspectives. Wissenschaftliche Verlagsgesellschaft, Stuttgart, pp 83–90
Kim CY, Tsai MH, Osmanian C, Graeber TG, Lee JE, Giffard RG, DiPaolo JA, Peehl DM, Giaccia AJ (1997) Selection of human cervical epithelial cells that possess reduced apoptotic potential to low-oxygen conditions. Cancer Res 57: 4200–4204
Knocke TH, Weitmann H-D, Feldmann H-J, Selzer E, Pötter R (1999) Intratumoral pO2-measurements as predictive assay in the treatment of carcinoma of the uterine cervix. Radiother Oncol 53: 99–104
Koong AC, Chen EY, Giaccia AJ (1994) Hypoxia causes the activation of nuclear factor κB through the phosphorylation of IκBα on tyrosine residues. Cancer Res 54: 1425–1430
Koong AC, Mehta VK, Le QT, Fisher GA, Terris DJ, Brown JM, Bastidas AJ, Vierra M (2000) Pancreatic tumors show high levels of hypoxia. Int J Radiat Oncol Biol Phys 48: 919–922
Kumar P (2000) Tumor hypoxia and anemia: Impact on the efficacy of radiation therapy. Sem Hematol 37: 4–8
Laderoute KR, Grant TD, Murphy BJ, Sutherland RM (1992) Enhanced epidermal growth factor receptor synthesis in human squamous carcinoma cells exposed to low levels of oxygen. Int J Cancer 52: 428–432
Laderoute KR, Calaoagan JM, Gustafson-Brown C, Knapp AM, Li G-C, Mendonca HL, Ryan HE, Wang Z, Johnson RS (2002) The response of c-Jun/ AP-1 to chronic hypoxia is hypoxia-inducible factor 1α dependent. Mol Cell Biol 22: 2515–2523
Lartigau E, Randrianarivelo H, Avril M-F, Margulis A, Spatz A, Eschwege F, Guichard M (1997) Intratumoral oxygen tension in metastatic melanoma. Melanoma Res 7: 400–406
Lavey RS (1999) Clinical trial experience using erythropoietin during radiation therapy. In: Vaupel P, Kelleher DK (eds) Tumor hypoxia. Pathophysiology, clinical significance and therapeutic perspectives. Wissenschaftliche Verlagsgesellschaft, Stuttgart, pp 99–105
Lawrentschuk N, Poon AMT, Foo SS, Johns Putra LG, Murone C, Davis ID, Bolton DM, Scott AM (2005) Assessing regional hypoxia in human renal tumours using 18F-fluoromisonidazole positron emission tomography. Br J Urol Internat 96: 540–546
Loncaster JA, Cooper RA, Logue JP, Davidson SE, Hunter RD, West CML (2000) Vascular endothelial growth factor (VEGF) expression is a prognostic factor for radiotherapy outcome in advanced carcinoma of the cervix. Br J Cancer 83: 620–625
Mattern J, Kallinowski F, Herfarth C, Volm M (1996) Association of resistancerelated protein expression with poor vascularization and low levels of oxygen in human rectal cancer. Int J Cancer 67: 20–23
Mayr NA, Yuh WTC, Magnotta VA, Ehrhardt JC, Wheeler JA, Sorosky JI, Davis CS, Wen B-C, Martin DD, Pelsang RE, Buller RE, Oberley LW, Mellenberg DE, Hussey DH (1996) Tumor perfusion studies using fast magnetic resonance imaging technique in advanced cervical cancer: a new noninvasive predictive assay. Int J Radiat Oncol Biol Phys 36: 623–633
Mitchell JB, McPherson S, De Graff W, Gamson J, Zabell A, Russo A (1985) Oxygen dependence of hematoporphyrin derivative-induced photo-inactivation of Chinese hamster cells. Cancer Res 45: 2008–2011
Moan J, Sommer S (1985) Oxygen dependence of the photosensitizing effect of hematoporphyrin derivative in NHIK 3025 cells. Cancer Res 45: 1608–1610
Moulder JE, Rockwell S (1987) Tumor hypoxia: its impact on cancer therapy. Cancer Metast Rev 5: 313–341
Movsas B, Chapman JD, Greenberg RE, Hanlon AL, Horwitz EM, Pinover WH, Stobbe C, Hanks GE (2000) Increasing levels of hypoxia in prostate carcinoma correlate significantly with increasing clinical stage and patient age. Cancer 89: 2018–2024
Movsas B, Chapman JD, Horwitz EM, Pinover WH, Greenberg RE, Hanlon AL, Iyer R, Hanks GE (1999) Hypoxic regions exist in human prostate carcinoma. Urology 53: 11–18
Nishi H, Nakada T, Kyo S, Inoue M, Shay JW, Isaka K (2004) Hypoxia-inducible factor 1 mediates upregulation of telomerase (hTERT). Mol Cell Biol 24: 6076–6083
Nordsmark M, Overgaard J (2000) A confirmatory prognostic study on oxygenation status and loco-regional control in advanced head and neck squamous cell carcinoma treated by radiation therapy. Radiother Oncol 57: 39–43
Nordsmark M, Overgaard J (2004) Tumor hypoxia is independent of hemoglobin and prognostic for loco-regional tumor control after primary radiotherapy in advanced head and neck cancer. Acta Oncol 43: 396–403
Nordsmark M, Hoyer M, Keller J, Nielsen OS, Jensen OM, Overgaard J (1996) The relationship between tumor oxygenation and cell proliferation in human soft tissue sarcomas. Int J Radiat Oncol Biol Phys 35: 701–708
Nordsmark M, Keller J, Nielsen OS, Lundorf E, Overgaard J (1997) Tumour oxygenation assessed by polarographic needle electrodes and bioenergetic status measured by 31P magnetic resonance spectroscopy in human soft tissue tumours. Acta Oncol 36: 565–571
Nordsmark M, Alsner J, Keller J, Nielsen OS, Jensen OM, Horsman MR, Overgaard J (2001) Hypoxia in human sof tissue sarcomas: adverse impact on survival and no association with p53 mutations. Br J Cancer 84: 1070–1075
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. Radiother Oncol 77: 18–24
Parker C, Milosevic M, Toi A, Sweet J, Panzarella T, Bristow R, Catton C, Catton P, Crook J, Gospodarowicz M, McLean M, Warde P, Hill RP (2004) Polarographic electrode study of tumor oxygenation in clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 58: 750–757
Powell MEB, Collingridge DR, Saunders MI, Hoskin PJ, Hill SA, Chaplin DJ (1999) Improvement in human tumour oxygenation with carbogen of varying carbon dioxide concentrations. Radiother Oncol 50: 167–171
Raleigh JA (ed) (1996) Hypoxia and its clinical significance. Semin Radiat Oncol 6: 1–70
Rampling R, Cruickshank G, Lewis AD, Fitzsimmons SA, Workman P (1994) Direct measurement of pO2 distribution and bioreductive enzymes in human malignant brain tumors. Int J Radiat Oncol Biol Phys 29: 427–432
Révész L, Siracká E, Siracký J, Delides G, Pavlaki K (1989) Variation of vascular density within and between tumors of the uterine cervix and its predictive value for radiotherapy. Int J Radiat Oncol Biol Phys 16: 1161–1163
Reynolds TY, Rockwell S, Glazer PM (1996) Genetic instability induced by the tumor microenvironment. Cancer Res 56: 5754–5757
Rice GC, Hoy C, Schimke RT (1986) Transient hypoxia enhances the frequency of dihydrofolate reductase gene amplification in Chinese hamster ovary cells. Proc Natl Acad Sci USA 83: 5978–5982
Russo CA, Weber TK, Volpe CM, Stoler DL, Petrelli NJ, Rodriguez-Bigas M, Burhans WC, Anderson GR (1995) An anoxia inducible endonuclease and enhanced DNA breakage as contributors to genomic instability in cancer. Cancer Res 55: 1122–1128
Sakata K, Kwok TT, Murphy BJ, Laderoute KR, Gordon GR, Sutherland RM (1991) Hypoxia-induced drug resistance: comparison to P-glycoproteinassociated drug resistance. Br J Cancer 64: 809–814
Sanna K, Rofstad EK (1994) Hypoxia-induced resistance to doxorubicin and methotrexate in human melanoma cell lines in vitro. Int J Cancer 58: 258–262
Semenza GL (2000a) Hypoxia, clonal selection, and the role of HIF-1 in tumor progression. Crit Rev Biochem Molec Biol 35: 71–103
Semenza GL (2000b) HIF-1: mediator of physiological and pathophysiological response to hypoxia. J Appl Physiol 88: 1474–1480
Shannon AM, Bouchier-Hayes DJ, Condron CM, Toomey D (2003) Tumour hypoxia, chemotherapeutic resistance and hypoxia-related therapies. Cancer Treat Rev 29: 297–307
Shannon AM, Bouchier-Hayes DJ, Condron CM, Toomey D (2005) Correction of anaemia through the use of darbepoetin alfa improves chemotherapeutic outcome in a murine model of Lewis lung carcinoma. Br J Cancer 93: 224–232
Silver DF, Piver MS (1999) Effects of recombinant human erythropoietin on the antitumor effect of cisplatin in SCID mice bearing human ovarian cancer: a possible oxygen effect. Gynecol Oncol 73: 280–284
Siracká E, Révész L, Kovác R, Siracký J (1988) Vascular density in carcinoma of the uterine cervix and its predictive value for radiotherapy. Int J Cancer 41: 819–822
Song CW, Lyons JC, Luo Y (1993) Intracellular pH in solid tumors: Influence on therapeutic response. In: Teicher BA (ed) Drug resistance in oncology. Marcel Dekker, New York, pp 25–51
Stackpole CW, Groszek L, Kalbag SS (1994) Benign-to-malignant B16 melanoma progression induced in two stages in vitro by exposure to hypoxia. J Natl Cancer Inst 86: 361–367
Stadler P, Becker A, Feldmann HJ, Hänsgen G, Dunst J, Würschmidt, Molls M (1999) Influence of the hypoxic subvolume on the survival of patients with head and neck cancer. Int J Radiat Oncol Biol 44: 749–754
Stoler DL, Anderson GR, Russo CA, Spina AM, Beerman A (1992) Anoxiainducible endonuclease activity as a potential basis of the genomic instability of cancer cells. Cancer Res 52: 4372–4378
Stüben G, Thews O, Pöttgen C, Knühmann K, Vaupel P, Stuschke M (2001) Recombinant human erythropoietin increases the radiosensitivity of xenografted human tumours in anaemic nude mice. J Cancer Res Clin Oncol 127: 346–350
Stüben G, Thews O, Pöttgen C, Knühmann K, Sack H, Stuschke M, Vaupel P (2003a) Impact of anemia prevention by recombinant human erythropoietin on the sensitivity of xenografted glioblastomas to fractionated irradiation. Strahlenther Onkol 179: 620–625
Stüben G, Pöttgen C, Knühmann K, Schmidt K, Stuschke M, Thews O, Vaupel P (2003b) Erythropoietin restores the anemia-induced reduction in radiosensitivity of experimental human tumors in nude mice. Int J Radiat Oncol Biol Phys 55: 1358–1362
Sundfor K, Lyng H, Rofstad EK (1998) Oxygen tension and vascular density in adenocarcinoma and squamous cell carcinoma of the uterine cervix. Acta Oncol 37: 665–670
Sundfor K, Lyng H, Trope CG, Rofstad EK (2000) Treatment outcome in advanced squamous cell carcinoma of the uterine cervix: relationships to pretreatment tumor oxygenation and vascularization. Radiother Oncol 54: 101–107
Sutherland RM (1998) Tumor hypoxia and gene expression. Implications for malignant progression and therapy. Acta Oncol 37: 567–574
Tannock IF, Hill RP, Bristow RG, Harrington (eds) (2005) The basic science of oncology, 4th edn. McGraw-Hill, New York
Teicher BA (ed) (1993) Drug resistance in oncology. Marcel Dekker, New York
Teicher BA (1994) Hypoxia and drug resistance. Cancer Metast 13: 139–168
Teicher BA (1995) Physiologic mechanisms of therapeutic resistance. Hematol/ Oncol Clinics North America 9: 475–506
Teicher BA, Lazo JS, Sartorelli AC (1981) Classification of antineoplastic agents by their selective toxicities toward oxygenated and hypoxic tumor cells. Cancer Res 41: 73–81
Teicher BA, Holden SA, Al-Achi A, Herman TS (1990) Classification of antineoplastic treatments by their differential toxicity toward putative oxygenated and hypoxic tumor subpopulations in vivo in the FSaII murine fibrosarcoma. Cancer Res 50: 3339–3344
Thews O, Kelleher DK, Vaupel P (2001) Erythropoietin restores the anemiainduced reduction in cyclophosphamide cytotoxicity in rat tumors. Cancer Res 61: 1358–1361
Thews O, Koenig R, Kelleher DK, Kutzner J, Vaupel P (1998) Enhanced radiosensitivity in experimental tumours following erythropoietin treatment of chemotherapy-induced anaemia. Br J Cancer 78: 752–756
Vaupel P (1994) Blood flow, oxygenation, tissue pH distribution and bioenergetic status of tumors. Ernst Schering Research Foundation, Lecture 23, Berlin
Vaupel P (1997a) Blood flow and oxygenation status of head and neck carcinomas. Adv Exp Med Biol 428: 89–95
Vaupel P (1997b) The influence of tumor blood flow and microenvironmental factors on the efficacy of radiation, drugs and localized hyperthermia. Klin Pädiatr 209: 243–249
Vaupel P (2001) Durchblutung und Oxygenierungsstatus von Kopf-Hals-Tumoren. In: Böttcher HD, Wendt TG, Henke M (Hrsg) Klinik des Rezidivtumors im Kopf-Hals-Bereich. Grundlagen — Diagnostik — Therapie. Zuckschwerdt, München Bern Wien New York, S 7–23
Vaupel P (2004) The role of hypoxia-induced factors in tumor progression. Oncologist 9: 10–17
Vaupel P (2004) Tumor microenvironmental physiology and its implications for radiation oncology. Semin Radiat Oncol 14: 198–206
Vaupel P, Harrison L (2004) Tumor hypoxia: Causative factors, compensatory mechanisms, and cellular response. Oncologist 9: 4–9
Vaupel P, Höckel M (1999) Oxygenation status of breast cancer: The Mainz experience. In: Vaupel P, Kelleher DK (eds) Tumor hypoxia. Pathophysiology, clinical significance and therapeutic perspectives. Wissenschaftliche Verlagsgesellschaft, Stuttgart, pp 1–11
Vaupel P, Höckel M (2000) Blood supply, oxygenation status and metabolic micromilieu of breast cancers: Characterization and therapeutic relevance. Int J Oncol 17: 869–879
Vaupel P, Höckel M (2001) Hypoxie beim Zervixkarzinom: Pathogenese, Charakterisierung und biologische/klinische Konsequenzen. Zentralbl Gynäkol 123: 192–197
Vaupel P, Kelleher DK (eds) (1999) Tumor hypoxia: pathophysiology, clinical significance and therapeutic perspectives. Wissenschaftliche Verlagsgesellschaft, Stuttgart
Vaupel P, Mayer A (2005) Effects of anaemia and hypoxia on tumour biology. In: Bokemeyer C, Ludwig H (eds) Anaemia in cancer, 2nd edn. Elsevier, Edingburgh London New York, pp 47–66
Vaupel P, Kallinowski F, Okunieff P (1989) Blood flow, oxygen and nutrient supply, and metabolic microenvironment of human tumors: A review. Cancer Res 49: 6449–6465
Vaupel P, Thews O, Hoeckel M (2001) Treatment resistance of solid tumors: role of hypoxia and anemia. Med Oncol 18: 243–259
Vaupel P, Mayer A, Höckel M (2004) Tumor hypoxia and malignant progression. Methods Enzymol 381: 335–354
Vaupel P, Schlenger K, Knoop C, Hoeckel M (1991) Oxygenation of human tumors: Evaluation of tissue oxygen distribution in breast cancers by computerized O2 tension measurements. Cancer Res 51: 3316–3322
Vaupel P, Thews O, Mayer A, Höckel S, Höckel M (2002) Oxygenation status of gynecologic tumors: What is the optimal hemoglobin level? Strahlenther Onkol 12: 727–731
Vera JC, Castillo GR, Rosen OM (1991) A possible role for a mammalian facilitative hexose transporter in the development of resistance to drugs. Mol Cell Biol 11: 3407–3418
Young SD, Marshall RS, Hill RP (1988) Hypoxia induces DNA overreplication and enhances metastatic potential of murine tumour cells. Proc Natl Acad Sci USA 85: 9533–9537
Wildiers H, Guetens G, de Boeck G, Landuyt W, Verbeken E, Highley M, de Brunn EA, van Oostrom AT (2002) Melphalan availability in hypoxia-inducible factor-1α+/+ and factor-1α−/− tumors is independent of tumor vessel density and correlates with melphalan erythrocyte transport. Int J Cancer 99: 514–519
Zeller WJ (1995) Bleomycin. In: Zeller WJ, zur Hausen H (Hrsg) Onkologie: Grundlagen, Diagnostik, Therapie, Entwicklungen. ecomed, Landsberg, pp IV–3.12, 1–7
Author information
Authors and Affiliations
Corresponding authors
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2008 Springer-Verlag/Wien
About this chapter
Cite this chapter
Vaupel, P., Höckel, M. (2008). Tumor hypoxia and therapeutic resistance. In: Nowrousian, M.R. (eds) Recombinant Human Erythropoietin (rhEPO) in Clinical Oncology. Springer, Vienna. https://doi.org/10.1007/978-3-211-69459-6_11
Download citation
DOI: https://doi.org/10.1007/978-3-211-69459-6_11
Publisher Name: Springer, Vienna
Print ISBN: 978-3-211-25223-9
Online ISBN: 978-3-211-69459-6
eBook Packages: MedicineMedicine (R0)