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The measurement and modification of hypoxia in colorectal cancer: overlooked but not forgotten

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Title: The measurement and modification of hypoxia in colorectal cancer: overlooked but not forgotten
Authors: Fletcher, E
Thompson, A
Ashrafian, H
Darzi, A
Item Type: Journal Article
Abstract: Tumour hypoxia is the inevitable consequence of a tumour’s rapid growth and disorganised, inefficient vasculature. The compensatory mechanisms employed by tumours, and indeed the absence of oxygen itself, hinder the ability of all treatment modalities. The clinical consequence is poorer overall survival, disease-free survival, and locoregional control. Recognising this, clinicians have been attenuating the effect of hypoxia, primarily with hypoxic modification or with hypoxia activated pro-drugs, and notable success has been demonstrated. However, in the case of colorectal cancer (CRC), there is a general paucity of knowledge and evidence surrounding the measurement and modification of hypoxia, and this is possibly due to the comparative inaccessibility of such tumours. We specifically review the role of hypoxia in CRC, and focus on: the current evidence for the existence of hypoxia in CRC, the majority of which originates from indirect positron emission topography (PET) imaging with hypoxia selective radiotracers; the evidence correlating CRC hypoxia with poorer oncological outcome, which is largely based on the measurement of Hypoxia Inducible Factor (HIF) in correlation with clinical outcome; the evidence of hypoxic modification in CRC, of which no direct evidence exists, but is reflected in a number of indirect markers; the prognostic and monitoring implications of accurate CRC hypoxia quantification and its potential in the field of precision oncology; and the present and future imaging tools and technologies being developed for the measurement of CRC hypoxia, including the use of blood oxygen level dependent (BOLD) MRI imaging and diffuse reflectance spectroscopy.
Issue Date: 25-Aug-2022
Date of Acceptance: 21-Jul-2022
URI: http://hdl.handle.net/10044/1/98565
DOI: 10.1093/gastro/goac042
ISSN: 2052-0034
Publisher: Oxford University Press
Start Page: 1
End Page: 13
Journal / Book Title: Gastroenterology Report
Volume: 10
Copyright Statement: © The Author(s) 2022. Published by Oxford University Press and Sixth Affiliated Hospital of Sun Yat-sen University This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Sponsor/Funder: National Institute of Health Research
Keywords: Science & Technology
Life Sciences & Biomedicine
Gastroenterology & Hepatology
hypoxia
colorectal neoplasm
prognostication
neoadjuvant chemoradiotherapy
SQUAMOUS-CELL CARCINOMA
GROWTH-FACTOR RECEPTOR
ADVANCED RECTAL-CANCER
TUMOR OXYGENATION
NEOADJUVANT CHEMORADIOTHERAPY
POSITRON-EMISSION
VASCULAR ARCHITECTURE
COMPLETE RESPONSE
HEMOGLOBIN LEVELS
INTRAVENOUS IRON
colorectal neoplasm
hypoxia
neoadjuvant chemoradiotherapy
prognostication
Publication Status: Published
Online Publication Date: 2022-08-25
Appears in Collections:Department of Surgery and Cancer
Faculty of Medicine
Institute of Global Health Innovation



This item is licensed under a Creative Commons License Creative Commons