title: Exploratory prospective trial of hypoxia-specific PET imaging during radiochemotherapy in patients with locally advanced head-and-neck cancer.
abstract: OBJECTIVE
  To explore in a prospective trial the prognostic value of hypoxia imaging before and during radiochemotherapy in patients with locally advanced head and neck cancer.
  
  
  METHODS
  Twenty-five patients with stage III/IV head and neck cancer were investigated with [(18)F]-fluoromisonidazole (FMISO) PET/CT at four time points during radiochemotherapy (baseline, 8-10 Gy, 18-20 Gy,50-60 Gy). FMISO PET/CT image parameters were extracted including maximum-tumour-to-background (TBR(max)) and thresholded volume at different TBR ratios. CT volume and baseline FDG-PET/CT image parameters were also included. Parameters at all time points were investigated for their prognostic value with the local-progression-free-survival endpoint (LPFS). Significance was evaluated with multivariate Cox (including clinical parameters) and Log-rank tests.
  
  
  RESULTS
  FMISO-image parameters were found to have a strong association with the LPFS endpoint, and were strongest at the week 1 and 2 time points (p = 0.023-0.048 and 0.042-0.061 respectively on multivariate Cox). Parameters measured at baseline were only significant on univariate analysis. None of the clinical parameters, and also FDG- or CT-delineated volumes, were significantly associated with LPFS.
  
  
  CONCLUSIONS
  This prospective, exploratory study demonstrated that FMISO-PET/CT imaging during the initial phase of treatment carries strong prognostic value. FMISO-PET/CT imaging at 1 or 2 weeks during treatment could be promising way to select patients that would benefit from hypoxia modification or dose-escalated treatment. A validation study is on-going.
authors.affiliation: Medical Faculty and University Hospital Carl Gustav Carus, Dresden, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Zips
authors.forename: Klaus
authors.initials: K
authors.lastname: Zöphel
authors.forename: Nasreddin
authors.initials: N
authors.lastname: Abolmaali
authors.forename: Rosalind
authors.initials: R
authors.lastname: Perrin
authors.forename: Andrij
authors.initials: A
authors.lastname: Abramyuk
authors.forename: Robert
authors.initials: R
authors.lastname: Haase
authors.forename: Steffen
authors.initials: S
authors.lastname: Appold
authors.forename: Jörg
authors.initials: J
authors.lastname: Steinbach
authors.forename: Jörg
authors.initials: J
authors.lastname: Kotzerke
authors.forename: Michael
authors.initials: M
authors.lastname: Baumann
mesh_terms: D000368:Aged; D015687:Cell Hypoxia; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D008920:Misonidazole / Q000031:analogs & derivatives; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies
chemical_list: C031843:fluoromisonidazole; D008920:Misonidazole