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Textural features of hypoxia PET predict survival in head and neck cancer during chemoradiotherapy

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Abstract

Purpose

The aim of this study was to investigate whether textural features of tumour hypoxia, assessed with serial [18F]fluoromisonidazole (FMISO)-PET, were able to predict clinical outcome in patients with head and neck squamous cell carcinoma (HNSCC, T1-4, N+, M0) during chemoradiotherapy (CRT).

Methods

In a preliminary evaluation of a prospective trial, tumour hypoxia was evaluated in 29 patients via serial FMISO-PET before and during CRT. All patients received an initial [18F]fluorodeoxyglucose (FDG)-PET before CRT, and tumour regions were defined on this FDG-PET. The first-order metrics tumour-to-background ratio (TBRmean, TBRmax, TBRpeak), coefficient of variation, total lesion uptake and integral non-uniformity were calculated for all scans. Further, 3 second-order (textural) features from two grey-level matrices were calculated, as well as differential non-uniformity (udiff). Prognostic value was examined by median split for group separation (GS) in Kaplan-Meier estimates and correlated with overall survival (OS), quantified via log-rank tests (p ≤ 0.05) and group-relative hazard ratios (HR).

Results

Within a median follow-up of 29.6 months (95% CI: 16.8–48.0 months), no first-order metrics predicted OS with a significant GS (all p > 0.05) on any FMISO-PET scan. Only udiff before and in week 2 during CRT (p = 0.03, HR = 10.8 and p = 0.05, HR = 5.2) and non-uniformity from grey-level run length matrix in week 2 separated prognostic groups (p = 0.05, HR = 5.3); lower values were correlated with better OS. Further, the decrease in udiff from before CRT to week 2 was correlated with better OS (p = 0.04, HR = 9.4). FDG-PET before CRT did not predict outcome in any measure.

Conclusions

Textural features on FMISO-PET scans before CRT, in week 2 and, to a limited degree, the change of features during CRT, were able to identify head and neck squamous cell carcinoma patients with better OS, suggesting that a higher homogeneity of the degree of hypoxia in tumours could correlate with a better outcome after CRT.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany

    A. Sörensen, C. Stoykow, P. T. Meyer & M. Mix

  2. Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany

    M. Carles, H. Bunea, L. Majerus, N. H. Nicolay, N. E. Wiedenmann, P. Vaupel & A. L. Grosu

  3. German Cancer Consortium (Deutsches Konsortium für Translationale Krebsforschung, DKTK) Partner Site Freiburg, 79106, Freiburg, Germany

    N. H. Nicolay, P. Vaupel, P. T. Meyer & A. L. Grosu

  4. Department of Medical Imaging and Clinical Oncology, Nuclear Medicine Division, Faculty of Medicine and Health Science, Stellenbosch University, Tygerberg, Cape Town, 7505, South Africa

    M. Mix

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  1. A. Sörensen
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Sörensen, A., Carles, M., Bunea, H. et al. Textural features of hypoxia PET predict survival in head and neck cancer during chemoradiotherapy. Eur J Nucl Med Mol Imaging 47, 1056–1064 (2020). https://doi.org/10.1007/s00259-019-04609-9

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