title: Serial [18F]-fluoromisonidazole PET during radiochemotherapy for locally advanced head and neck cancer and its correlation with outcome.
abstract: OBJECTIVE
  The aim was to assess changes of tumour hypoxia during primary radiochemotherapy (RCT) for head and neck cancer (HNC) and to evaluate their relationship with treatment outcome.
  
  
  METHODS
  Hypoxia was assessed by FMISO-PET in weeks 0, 2 and 5 of RCT. The tumour volume (TV) was determined using FDG-PET/MRI/CT co-registered images. The level of hypoxia was quantified on FMISO-PET as TBRmax (SUVmaxTV/SUVmean background). The hypoxic subvolume (HSV) was defined as TV that showed FMISO uptake ⩾1.4 times blood pool activity.
  
  
  RESULTS
  Sixteen consecutive patients (T3-4, N+, M0) were included (mean follow-up 31, median 44months). Mean TBRmax decreased significantly (p<0.05) from 1.94 to 1.57 (week 2) and 1.27 (week 5). Mean HSV in week 2 and week 5 (HSV2=5.8ml, HSV3=0.3ml) were significantly (p<0.05) smaller than at baseline (HSV1=15.8ml). Kaplan-Meier plots of local recurrence free survival stratified at the median TBRmax showed superior local control for less hypoxic tumours, the difference being significant at baseline and after 2weeks (p=0.031, p=0.016).
  
  
  CONCLUSIONS
  FMISO-PET documented that in most HNC reoxygenation starts early during RCT and is correlated with better outcome.
authors.affiliation: Department of Radiation Oncology, German Cancer Consortium/Partner site Freiburg, University Medical Center Freiburg, Germany.
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Wiedenmann
authors.affiliation: Department of Radiation Oncology, German Cancer Consortium/Partner site Freiburg, University Medical Center Freiburg, Germany; Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Switzerland.
authors.forename: Sabine
authors.initials: S
authors.lastname: Bucher
authors.affiliation: Department of Nuclear Medicine, Inselspital Bern, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Hentschel
authors.affiliation: Department of Nuclear Medicine, University Medical Center Freiburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Mix
authors.affiliation: Center for Medical Biometry and Medical Informatics, University Medical Center Freiburg, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Vach
authors.affiliation: Department of Radiation Oncology, German Cancer Consortium/Partner site Freiburg, University Medical Center Freiburg, Germany.
authors.forename: Martin-Immanuel
authors.initials: MI
authors.lastname: Bittner
authors.affiliation: Department of Radiation Oncology, German Cancer Consortium/Partner site Freiburg, University Medical Center Freiburg, Germany.
authors.forename: Ursula
authors.initials: U
authors.lastname: Nestle
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Freiburg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Pfeiffer
authors.affiliation: Department of Nuclear Medicine, University Medical Center Freiburg, Germany; Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center, New York, USA.
authors.forename: Wolfgang A
authors.initials: WA
authors.lastname: Weber
authors.affiliation: Department of Radiation Oncology, German Cancer Consortium/Partner site Freiburg, University Medical Center Freiburg, Germany.
authors.forename: Anca L
authors.initials: AL
authors.lastname: Grosu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D059248:Chemoradiotherapy; D005240:Feasibility Studies; D005260:Female; D005462:Fluorine Radioisotopes; D006258:Head and Neck Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D000860:Hypoxia / Q000000981:diagnostic imaging / Q000209:etiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008920:Misonidazole / Q000031:analogs & derivatives; D049268:Positron-Emission Tomography / Q000379:methods; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D005462:Fluorine Radioisotopes; C031843:fluoromisonidazole; D008920:Misonidazole
keywords: 18F-MISO; Head and neck cancer; Hypoxia; PET; Radiochemotherapy