title: Hypoxia-imaging with (18)F-Misonidazole and PET: changes of kinetics during radiotherapy of head-and-neck cancer.
abstract: OBJECTIVE
  PET with (18)F-Misonidazole (FMISO-PET) is a non-invasive method for measuring tumor hypoxia. We analysed changes of FMISO-uptake during radiotherapy and their impact on patient outcome.
  
  
  METHODS
  Fourteen patients with HNC underwent repeated FMISO-PET prior to radiotherapy and after 30Gy. Dynamic and static PET-scans (2+4h p.i.) were acquired. FMISO-uptake was quantified by calculating standard uptake values (SUV) and tumor-muscle-ratios (TMR). Kinetic curve types representing tissue hypoxia were defined. Change of curve type was correlated with patient outcome.
  
  
  RESULTS
  The mean SUV 4h p.i. and the TMR decreased significantly during radiotherapy. SUV decreased clearly in 12/14 patients, and increased in 2 patients. TMR decreased in 11 patients, and increased in 3 patients. Prior to radiotherapy, three different shapes of kinetic curve types indicative for the degree of hypoxia could be defined in 12/14 patients: (1) accumulation type (severe hypoxia (n=8)), (2) intermediate type (intermediate degree of hypoxia (n=3)), and (3) wash-out type (low degree of hypoxia (n=1)). Curve type changed towards a lower degree of hypoxia at 30Gy in all but 3 patients. In three patients curve type remained unchanged.
  
  
  CONCLUSIONS
  The changes in tumor FMISO-uptake during radiotherapy indicate radio-induced reoxygenation.
authors.affiliation: Department of Nuclear medicine, Marienhospital Stuttgart, Germany. susanneeschmann@vinzenz.de
authors.forename: Susanne Martina
authors.initials: SM
authors.lastname: Eschmann
authors.forename: Frank
authors.initials: F
authors.lastname: Paulsen
authors.forename: Claudia
authors.initials: C
authors.lastname: Bedeshem
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Machulla
authors.forename: Thomas
authors.initials: T
authors.lastname: Hehr
authors.forename: Michael
authors.initials: M
authors.lastname: Bamberg
authors.forename: Roland
authors.initials: R
authors.lastname: Bares
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000378:metabolism / Q000532:radiotherapy*; D015687:Cell Hypoxia; D005260:Female; D005462:Fluorine Radioisotopes; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism / Q000532:radiotherapy*; D006801:Humans; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D008920:Misonidazole / Q000493:pharmacokinetics*; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D011838:Radiation-Sensitizing Agents / Q000493:pharmacokinetics*
chemical_list: D005462:Fluorine Radioisotopes; D011838:Radiation-Sensitizing Agents; D008920:Misonidazole