Advantage of FMISO-PET over FDG-PET for predicting histological response to preoperative chemotherapy in patients with oral squamous cell carcinoma
- 554 Downloads
Hypoxia, a prognostic factor in many types of cancer, can be detected by 18F-fluoromisonidazole (FMISO) positron emission tomography (PET). It is unclear whether hypoxia reflects the response to chemotherapy in patients with oral squamous cell carcinoma (OSCC). The correlations of FMISO-PET and FDG-PET with histological response to preoperative chemotherapy were therefore assessed in patients with OSCC.
This study enrolled 22 patients with OSCC undergoing preoperative chemotherapy. The T-stages were T2 in 6 patients, T3 in 3, and T4a in 13, and the N-stages were N0 in 14 patients, N1 in 3, and N2 in 5. Each patient was evaluated by both FMISO-PET and FDG-PET before surgery, and the maximum standardized uptake value (SUVmax) of FDG- and FMISO-PET and tumor-muscle ratio (TMR) of FMISO-PET were measured. The threshold for the hypoxic volume based on TMR was set at 1.25. The histological response to preoperative chemotherapy was evaluated using operative materials.
FMISO-PET and FDG-PET detected uptake by primary OSCCs in 15 (68 %) and 21 (95 %) patients, respectively, and median SUVmaxs of FMISO- and FDG-PET in the primary site were 2.0 (range, 1.3–3.5) and 16.0 (range, 1.0–32.2), respectively. The median of FMISO TMR was 1.5 (range, 0.99–2.96). There were five cases whose FMISO TMR was less than 1.25. Histological evaluation showed good response to preoperative chemotherapy in 7 patients (32 %) and poor response in 15 (68 %). Good response was significantly more prevalent in patients with negative than positive FMISO uptake (P < 0.001) and without the hypoxic area evaluated by FMISO-PET TMR (P = 0.04), whereas FDG uptake was not significantly correlated with response to chemotherapy response. Multivariate logistic regression analysis showed that FMISO uptake was an independent significant predictor of response to preoperative chemotherapy (P = 0.03, odds ratio = 0.06, 95 % confidence interval = 0.004–0.759).
An advantage of FMISO-PET over FDG-PET for predicting histological response to preoperative chemotherapy in patients with OSCC was observed.
KeywordsHypoxia FMISO-PET FDG-PET Preoperative chemotherapy HIF-1α Oral squamous cell carcinoma
This study was partially supported by a Grant-in-Aid for Scientific Research (2010–2011: 22592203).
Conflict of interest
None of the authors of this manuscript has any financial relationship with any organization, or any conflict of interest, regarding this study.
- 9.Swisher SG, Erasmus J, Maish M, Correa AM, Macapinlac H, Ajani JA, et al. 2-fluoro-2-deoxy-d-glucose positron emission tomography imaging is predictive of pathologic response and survival after preoperative chemoradiation in patients with esophageal carcinoma. Cancer. 2004;101:1776–85.PubMedCrossRefGoogle Scholar
- 20.Jansen JFA, Schöder H, Lee NY, Wang Y, Pfister DG, Fury MG, et al. Noninvasive assessment of tumor microenviroment using dynamic contrast-enhanced magnetic resonance imaging and 18F-fluoromisonidazole positron emission tomography imaging in neck nodal metastases. Int J Radiat Oncol Biol Phys. 2010;77:1403–10.PubMedCrossRefPubMedCentralGoogle Scholar
- 31.Barnes L, Eveson J, Reichart P, Barnes L, Sidransky D. World Health Organization Classification of Tumors, Pathology and Genetics of Tumors of the Head and Neck. International Agency for Research on Cancer. Lyon: IARC Press; 2005.Google Scholar
- 32.Sobin LH, Wittenkind CH. TNM Classification of Malignant Tumors. 5th ed. New York: John Wiley & Sons, Inc; 1997. p. 17–42.Google Scholar
- 34.Japan Society for Head and Neck Cancer. General rules for clinical studies on head and neck cancer. 5th ed. Tokyo: KANEHARS & Co., LTD; 2012. p. 68.Google Scholar
- 46.Hawkins DS, Rajendran JG, Conrad 3rd EU, Bruckner JD. Evaluation of chemotherapy response in pediatric bone sarcomas by [F-18]-fluorodeoxy-D-glucose positron emission tomography. Cancer. 2002;94:3277–84.Google Scholar
- 50.Kalz S, Kalzova N, Liao SY, Lwman N, Stanbridge EJ. Transcriptional control of the tumor- and hypoxia-marker carbonic anhydrase 9: a one transcription factor (HIF-1) show? Biochem Biophys Acta. 2009;1795:162–72.Google Scholar
- 53.Rajendran JG, Mankoff DA, O’Sullivan F, Peterson LM, Schwartz DL, Conrad EU, et al. Hypoxia and glucose metabolism in malignant tumor: evaluation by [18F] fluoromisonidazole and [18F] fluorodeoxyglucose positron emission tomography imaging. Clin Cancer Res. 2004;10:2245–52.PubMedCrossRefGoogle Scholar
- 54.Shimosato Y, Oboshi S, Baba K. Histological evaluation of effects of radiotherapy and chemotherapy for carcinoma. J Clin Oncol. 1971;1:19–35.Google Scholar