18F-fluoromisonidazole positron emission tomography before treatment is a predictor of radiotherapy outcome and survival prognosis in patients with head and neck squamous cell carcinoma
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To evaluate the usefulness of [18F]fluoromisonidazole ([18F]FMISO)-positron emission tomography (PET) prior to the treatment of head and neck squamous cell carcinoma.
Seventeen patients with untreated HNSCC underwent pretreatment [18F]FMISO PET. Six of them underwent definitive surgery and the remaining 11 definitive (chemo-)radiotherapy. We evaluated 30 lesions from the 17 patients. SUVmax and tumor-to-muscle ratios (TMR) were measured as hypoxia indicators. Tumors equal to or above the median value were defined as tumor with high uptake of [18F]FMISO and those below as tumor with low uptake of [18F]FMISO in both indicators. Local control rates with radiotherapy, event-free survival and disease-specific survival (DSS) rates with radiotherapy or operation were compared.
[18F]FMISO-PET imaging of 30 lesions resulted in a SUVmax median value of 2.3 and a TMR median value of 1.3. Local control rates with radiotherapy (20-month median follow-up duration) were significantly lower in the tumor group with high uptake of [18F]FMISO compared to the tumor group with low uptake of [18F]FMISO using either SUVmax or TMR as the hypoxic indicator (P = 0.02 and 0.04, respectively). DSS rate with radiotherapy or operation (21-month median follow-up duration) was significantly lower in the patient group with high uptake of [18F]FMISO compared to the patient group with low uptake of [18F]FMISO defined by SUVmax (P = 0.04), but was not by TMR (P = 0.57).
Radiotherapy outcome and survival prognosis (radiotherapy or operation) in HNSCC may be predicted by carrying out [18F]FMISO PET before treatment.
- Jain RK. Tumor angiogenesis and accessibility: role of vascular endothelial growth factor. Semin Oncol. 2002;29:3–9.
- Piert M. Hypoxia Imaging. In: Wahl RL, editor. Principles and practice of PET and PET/CT. Philadelphia: Lippincott Williams and Wilkins; 2009. p. 464–71.
- Wouters A, Pauwels B, Lardon F, Vermorken JB. Review: implications of in vitro research on the effect of radiotherapy and chemotherapy under hypoxic conditions. Oncologist. 2007;12:690–712. CrossRef
- Stadler P, Becker A, Feldmann HJ, Hänsgen G, Dunst J, Würschmidt F, et al. Influence of the hypoxic subvolume on the survival of patients with head and neck cancer. Int J Radiat Oncol Biol Phys. 1999;44:749–54. CrossRef
- Lartigau E, Lusinchi A, Weeger P, Wibault P, Luboinski B, Eschwege F, et al. Variations in tumour oxygen tension (pO2) during accelerated radiotherapy of head and neck carcinoma. Eur J Cancer. 1998;34:856–61. CrossRef
- Hockel M, Schlenger K, Aral B, Mitze M, Schaffer U, Vaupel P, et al. Association between tumor hypoxia and malignant progression in advanced cancer of the uterine cervix. Cancer Res. 1996;56:4509–15.
- Nordsmark M, Alsner J, Keller J, Nielsen OS, Jensen OM, Horsman MR, et al. Hypoxia in human soft tissue sarcomas: adverse impact on survival and no association with p53 mutations. Br J Cancer. 2001;84:1070–5. CrossRef
- Clavo B, Pérez JL, López L, Suárez G, Lloret M, Morera J, et al. Influence of haemoglobin concentration and peripheral muscle pO2 on tumour oxygenation in advanced head and neck tumours. Radiother Oncol. 2003;66:71–4. CrossRef
- Chapman JD. Hypoxic sensitizers—implications for radiation therapy. N Engl J Med. 1979;301:1429–32. CrossRef
- Jerabek PA, Patrick TB, Kilbourn MR, Dischino DD, Welch MJ. Synthesis and biodistribution of 18F-labeled fluoronitroimidazoles: potential in vivo markers of hypoxic tissue. Int J Rad Appl Instrum A. 1986;37:599–605. CrossRef
- Grierson JR, Link JM, Mathis CA, Rasey JS, Krohn KA. A radiosynthesis of fluorine-18 fluoromisonidazole. J Nucl Med. 1989;30:343–50.
- Yamane T, Kikuchi M, Shinohara S, Senda M. Reduction of [(18)F]fluoromisonidazole uptake after neoadjuvant chemotherapy for head and neck squamous cell carcinoma. Mol Imaging Biol. 2011;13:227–31. CrossRef
- Kikuchi M, Shinohara S, Nakamoto Y, Usami Y, Fujiwara K, Adachi T, et al. Sequential FDG-PET/CT after neoadjuvant chemotherapy is a predictor of histopathologic response in patients with head and neck squamous cell carcinoma. Mol Imaging Biol. 2011;13:368–77. CrossRef
- Tang G, Wang M, Tang X, Gan M, Luo L. Fully automated one-pot synthesis of [18F]fluoromisonidazole. Nucl Med Biol. 2005;32:553–8. CrossRef
- Oh SJ, Chi DY, Mosdzianowski C, Kim JY, Gil HS, Kang SH, et al. Fully automated synthesis of [18F]fluoromisonidazole using a conventional [18F]FDG module. Nucl Med Biol. 2005;32:899–905. CrossRef
- Eschmann SM, Paulsen F, Reimold M, Dittmann H, Welz S, Reischl G, et al. Prognostic impact of hypoxia imaging with 18F-misonidazole PET in non-small cell lung cancer and head and neck cancer before radiotherapy. J Nucl Med. 2005;46:253–60.
- Gray LH, Conger AD, Ebert M, Hornsey S, Scott OC. The concentration of oxygen dissolved in tissues at the time of irradiation as a factor in radiotherapy. Br J Radiol. 1953;26:638–48. CrossRef
- Brown JM. The hypoxic cell: a target for selective cancer therapy–eighteenth Bruce F Cain Memorial Award lecture. Cancer Res. 1999;59:5863–70.
- Horan AD, Koch CJ. The Km for radiosensitization of human tumor cells by oxygen is much greater than 3 mmHg and is further increased by elevated levels of cysteine. Radiat Res. 2001;156:388–98. CrossRef
- Rasey JS, Grunbaum Z, Magee S, Nelson NJ, Olive PL, Durand RE, et al. Characterization of radiolabeled fluoromisonidazole as a probe for hypoxic cells. Radiat Res. 1987;111:292–304. CrossRef
- Rasey JS, Nelson NJ, Chin L, Evans ML, Grunbaum Z. Characteristics of the binding of labeled fluoromisonidazole in cells in vitro. Radiat Res. 1990;122:301–8. CrossRef
- Rasey JS, Koh WJ, Evans ML, Peterson LM, Lewellen TK, Graham MM, et al. Quantifying regional hypoxia in human tumors with positron emission tomography of [18F]fluoromisonidazole: a pretherapy study of 37 patients. Int J Radiat Oncol Biol Phys. 1996;36:417–28. CrossRef
- Nordsmark M, Overgaard M, Overgaard J. Pretreatment oxygenation predicts radiation response in advanced squamous cell carcinoma of the head and neck. Radiother Oncol. 1996;41:31–9.
- Gagel B, Piroth M, Pinkawa M, Reinartz P, Zimny M, Kaiser HJ, et al. pO polarography, contrast enhanced color duplex sonography (CDS), [18F] fluoromisonidazole and [18F] fluorodeoxyglucose positron emission tomography: validated methods for the evaluation of therapy-relevant tumor oxygenation or only bricks in the puzzle of tumor hypoxia? BMC Cancer. 2007;7:113.
- Gagel B, Reinartz P, Demirel C, Kaiser HJ, Zimny M, Piroth M, et al. [18F] fluoromisonidazole and [18F] fluorodeoxyglucose positron emission tomography in response evaluation after chemo-/radiotherapy of non-small-cell lung cancer: a feasibility study. BMC Cancer. 2006;6:51.
- Tatum JL, Kelloff GJ, Gillies RJ, Arbeit JM, Brown JM, Chao KS, et al. Hypoxia: importance in tumor biology, noninvasive measurement by imaging, and value of its measurement in the management of cancer therapy. Int J Radiat Biol. 2006;82:699–757. CrossRef
- Kubota K, Tada M, Yamada S, Hori K, Saito S, Iwata R, et al. Comparison of the distribution of fluorine-18 fluoromisonidazole, deoxyglucose and methionine in tumour tissue. Eur J Nucl Med. 1999;26:750–7. CrossRef
- Spence AM, Muzi M, Swanson KR, O’Sullivan F, Rockhill JK, Rajendran JG, et al. Regional hypoxia in glioblastoma multiforme quantified with [18F]fluoromisonidazole positron emission tomography before radiotherapy: correlation with time to progression and survival. Clin Cancer Res. 2008;14:2623–30. CrossRef
- Rajendran JG, Schwartz DL, O’Sullivan J, Peterson LM, Ng P, Scharnhorst J, et al. Tumor hypoxia imaging with [F-18] fluoromisonidazole positron emission tomography in head and neck cancer. Clin Cancer Res. 2006;12:5435–41. CrossRef
- Thorwarth D, Eschmann SM, Paulsen F, Alber M. A kinetic model for dynamic [18F]-FMISO PET data to analyse tumour hypoxia. Phys Med Biol. 2005;50:2209–24. CrossRef
- 18F-fluoromisonidazole positron emission tomography before treatment is a predictor of radiotherapy outcome and survival prognosis in patients with head and neck squamous cell carcinoma
Annals of Nuclear Medicine
Volume 25, Issue 9 , pp 625-633
- Cover Date
- Print ISSN
- Online ISSN
- Springer Japan
- Additional Links
- [18F]fluoromisonidazole ([18F]FMISO)
- Positron emission tomography (PET)
- Head and neck cancer
- Prediction of prognosis
- Industry Sectors
- Author Affiliations
- 1. Department of Otolaryngology, Head and Neck Surgery, Kobe City Medical Center General Hospital, 4-6 Minatojima-Nakamachi, Chuo-ku, Kobe, 650-0046, Japan
- 2. Division of Molecular Imaging, Institute of Biomedical Research and Innovation, Kobe, Japan
- 3. Department of Otolaryngology, Shizuoka General Hospital, Shizuoka, Japan