title: Tumor hypoxia imaging with [F-18] fluoromisonidazole positron emission tomography in head and neck cancer.
abstract: OBJECTIVE
  Advanced head and neck cancer shows hypoxia that results in biological changes to make the tumor cells more aggressive and less responsive to treatment resulting in poor survival. [F-18] fluoromisonidazole (FMISO) positron emission tomography (PET) has the ability to noninvasively quantify regional hypoxia. We investigated the prognostic effect of pretherapy FMISO-PET on survival in head and neck cancer.
  
  
  METHODS
  Seventy-three patients with head and neck cancer had pretherapy FMISO-PET and 53 also had fluorodeoxyglucose (FDG) PET under a research protocol from April 1994 to April 2004.
  
  
  RESULTS
  Significant hypoxia was identified in 58 patients (79%). The mean FMISO tumor/bloodmax (T/Bmax) was 1.6 and the mean hypoxic volume (HV) was 40.2 mL. There were 28 deaths in the follow-up period. Mean FDG standard uptake value (SUV)max was 10.8. The median time for follow-up was 72 weeks. In a univariate analysis, T/Bmax (P=0.002), HV (P=0.04), and the presence of nodes (P=0.01) were strong independent predictors. In a multivariate analysis, including FDG SUVmax, no variable was predictive at P<0.05. When FDG SUVmax was removed from the model (resulting in n=73 with 28 events), nodal status and T/Bmax (or HV) were both highly predictive (P=0.02, 0.006 for node and T/Bmax, respectively; P=0.02 and 0.001 for node and HV, respectively).
  
  
  CONCLUSIONS
  Pretherapy FMISO uptake shows a strong trend to be an independent prognostic measure in head and neck cancer.
authors.affiliation: Department of Radiology, University of Washington, Veterans' Administration Puget Sound Health Care System, Seattle 98195, USA. rajan@u.washington.edu
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Rajendran
authors.forename: David L
authors.initials: DL
authors.lastname: Schwartz
authors.forename: Janet
authors.initials: J
authors.lastname: O'Sullivan
authors.forename: Lanell M
authors.initials: LM
authors.lastname: Peterson
authors.forename: Patrick
authors.initials: P
authors.lastname: Ng
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Scharnhorst
authors.forename: John R
authors.initials: JR
authors.lastname: Grierson
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Krohn
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000556:secondary; D015687:Cell Hypoxia; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D006801:Humans; D008875:Middle Aged; D008920:Misonidazole / Q000031:analogs & derivatives*; D015999:Multivariate Analysis; D049268:Positron-Emission Tomography / Q000379:methods*; D016019:Survival Analysis
chemical_list: C031843:fluoromisonidazole; D019788:Fluorodeoxyglucose F18; D008920:Misonidazole