title: 3D modeling of effects of increased oxygenation and activity concentration in tumors treated with radionuclides and antiangiogenic drugs.
abstract: OBJECTIVE
  Formation of new blood vessels (angiogenesis) in response to hypoxia is a fundamental event in the process of tumor growth and metastatic dissemination. However, abnormalities in tumor neovasculature often induce increased interstitial pressure (IP) and further reduce oxygenation (pO2) of tumor cells. In radiotherapy, well-oxygenated tumors favor treatment. Antiangiogenic drugs may lower IP in the tumor, improving perfusion, pO2 and drug uptake, by reducing the number of malfunctioning vessels in the tissue. This study aims to create a model for quantifying the effects of altered pO2-distribution due to antiangiogenic treatment in combination with radionuclide therapy.
  
  
  METHODS
  Based on experimental data, describing the effects of antiangiogenic agents on oxygenation of GlioblastomaMultiforme (GBM), a single cell based 3D model, including 10(10) tumor cells, was developed, showing how radionuclide therapy response improves as tumor oxygenation approaches normal tissue levels. The nuclides studied were 90Y, 131I, 177Lu, and 211At. The absorbed dose levels required for a tumor control probability (TCP) of 0.990 are compared for three different log-normal pO2-distributions: micro1 = 2.483, sigma1 = 0.711; micro2 = 2.946, sigma2 = 0.689; micro3 = 3.689, and sigma3 = 0.330. The normal tissue absorbed doses will, in turn, depend on this. These distributions were chosen to represent the expected oxygen levels in an untreated hypoxic tumor, a hypoxic tumor treated with an anti-VEGF agent, and in normal, fully-oxygenated tissue, respectively. The former two are fitted to experimental data. The geometric oxygen distributions are simulated using two different patterns: one Monte Carlo based and one radially increasing, while keeping the log-normal volumetric distributions intact. Oxygen and activity are distributed, according to the same pattern.
  
  
  RESULTS
  As tumor pO2 approaches normal tissue levels, the therapeutic effect is improved so that the normal tissue absorbed doses can be decreased by more than 95%, while retaining TCP, in the most favorable scenario and by up to about 80% with oxygen levels previously achieved in vivo, when the least favourable oxygenation case is used as starting point. The major difference occurs in poorly oxygenated cells. This is also where the pO2-dependence of the oxygen enhancement ratio is maximal.
  
  
  CONCLUSIONS
  Improved tumor oxygenation together with increased radionuclide uptake show great potential for optimising treatment strategies, leaving room for successive treatments, or lowering absorbed dose to normal tissues, due to increased tumor response. Further studies of the concomitant use of antiangiogenic drugs and radionuclide therapy therefore appear merited.
authors.affiliation: Department of Radiation Physics, Göteborg University, Göteborg 41345, Sweden. Jakob@radfys.gu.se
authors.forename: Jakob H
authors.initials: JH
authors.lastname: Lagerlöf
authors.forename: Jon
authors.initials: J
authors.lastname: Kindblom
authors.forename: Peter
authors.initials: P
authors.lastname: Bernhardt
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D005909:Glioblastoma / Q000098:blood supply / Q000188:drug therapy / Q000378:metabolism / Q000532:radiotherapy; D006801:Humans; D021621:Imaging, Three-Dimensional; D008954:Models, Biological; D015233:Models, Statistical; D009369:Neoplasms / Q000098:blood supply / Q000188:drug therapy* / Q000378:metabolism / Q000532:radiotherapy*; D010101:Oxygen Consumption / Q000187:drug effects / Q000528:radiation effects; D011868:Radioisotopes / Q000627:therapeutic use*; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors
chemical_list: D020533:Angiogenesis Inhibitors; D011868:Radioisotopes; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A