Utility of FMISO PET in advanced head and neck cancer treated with chemoradiation incorporating a hypoxia-targeting chemotherapy agent

  • Rodney J. Hicks
  • Danny Rischin
  • Richard Fisher
  • David Binns
  • Andrew M. Scott
  • Lester J. Peters
Original Article

DOI: 10.1007/s00259-005-1880-2

Cite this article as:
Hicks, R.J., Rischin, D., Fisher, R. et al. Eur J Nucl Med Mol Imaging (2005) 32: 1384. doi:10.1007/s00259-005-1880-2
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Abstract

Purpose

The purpose of the study was to evaluate [18F]fluoromisonidazole (FMISO) PET in advanced head and neck cancer during hypoxia-targeting therapy.

Methods

Fifteen of 16 patients in a phase I trial of chemoradiation plus tirapazamine (specific cytotoxin for hypoxic cells) in advanced (T3/4 and/or N2/3) head and neck cancer underwent serial [18F]fluorodeoxyglucose (FDG) and FMISO PET. We have previously reported excellent early clinical outcome of these patients and now review FMISO PET results in the context of longer follow-up of this patient cohort.

Results

Based on blinded qualitative scoring by two readers, FMISO PET was positive in 13/15 patients at baseline: 12/15 of primary sites and 8/13 neck nodes were scored as positive. All sites of corresponding FDG and FMISO abnormality at baseline showed marked qualitative reduction of uptake within 4 weeks of commencing therapy, consistent with effective hypoxia-targeted therapy. With a median follow-up of 6.9 years, there have been only four locoregional failures, while three other patients have died of metachronous lung cancer. The 5-year overall survival was 50% (95% CI 27–73%), the 5-year failure-free survival was 44% (95% CI 22–68%) and the 5-year freedom from locoregional failure was 68% (95% CI 38–88%).

Conclusion

The high prevalence of hypoxia demonstrated on FMISO PET imaging is consistent with the advanced disease stage of these patients and would be expected to predict an adverse prognosis. Evidence of the early resolution of FMISO abnormality during treatment, associated with excellent locoregional control in this patient cohort, supports further investigation of hypoxia-targeting agents in advanced head and neck cancer.

Keywords

PET Advanced head and neck cancer Chemoradiotherapy Hypoxia 

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Rodney J. Hicks
    • 1
    • 2
  • Danny Rischin
    • 2
    • 3
  • Richard Fisher
    • 4
  • David Binns
    • 1
  • Andrew M. Scott
    • 5
  • Lester J. Peters
    • 6
  1. 1.Centre for Molecular ImagingPeter MacCallum Cancer CentreMelbourneAustralia
  2. 2.Department of Medicine, St Vincent’s Medical SchoolUniversity of MelbourneMelbourneAustralia
  3. 3.Division of Haematology and Medical OncologyPeter MacCallum Cancer CentreMelbourneAustralia
  4. 4.Centre for Biostatistics and Clinical TrialsPeter MacCallum Cancer CentreMelbourneAustralia
  5. 5.Centre for PET, and Ludwig Institute for Cancer ResearchAustin HospitalMelbourneAustralia
  6. 6.Division of Radiation OncologyPeter MacCallum Cancer CentreMelbourneAustralia

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