title: Quantitative and qualitative analysis of [(18)F]FDG and [(18)F]FAZA positron emission tomography of head and neck cancers and associations with HPV status and treatment outcome.
abstract: OBJECTIVE
  While methods for imaging tumor hypoxia with positron emission tomography (PET) have been developed, optimal methods for interpreting and utilizing these datasets in the clinic remain unclear. In this study, we analyzed hypoxia PET images of head and neck cancer patients and compared imaging metrics with human papilloma virus (HPV) status and clinical outcome.
  
  
  METHODS
  Forty-one patients treated as part of a phase III trial of the hypoxic cytotoxin tirapazamine (TROG 02.02) were imaged with PET using fluorodeoxyglucose (FDG) and fluoroazomycin arabinoside (FAZA). FDG and FAZA PET images were interpreted qualitatively and quantitatively, and compared with tumor T stage, HPV status, and treatment outcome using multivariate statistics.
  
  
  RESULTS
  PET signals in the tumor and lymph nodes exhibited significant intra- and inter-patient variability. The FAZA hypoxic volume demonstrated a significant correlation with tumor T stage. PET-hypoxic tumors treated with cisplatin exhibited significantly worse treatment outcomes relative to PET-oxic tumors or PET-hypoxic tumors treated with tirapazamine.
  
  
  CONCLUSIONS
  Quantitative analysis of FAZA PET yielded metrics that correlated with clinical T stage and were capable of stratifying patient outcome. These results encourage further development of this technology, with particular emphasis on establishment of robust quantitative methods.
authors.affiliation: Department of Radiation Oncology, Stanford University, 269 Campus Dr., CCSR South Rm. 1255A, Stanford, CA, 94305-5152, USA. egraves@stanford.edu.
authors.forename: Edward E
authors.initials: EE
authors.lastname: Graves
authors.affiliation: Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Hicks
authors.affiliation: Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Binns
authors.affiliation: Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Mathias
authors.initials: M
authors.lastname: Bressel
authors.affiliation: Department of Radiation Oncology, Stanford University, 269 Campus Dr., CCSR South Rm. 1255A, Stanford, CA, 94305-5152, USA.
authors.forename: Quynh-Thu
authors.initials: QT
authors.lastname: Le
authors.affiliation: Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Lester
authors.initials: L
authors.lastname: Peters
authors.affiliation: Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Young
authors.affiliation: Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Danny
authors.initials: D
authors.lastname: Rischin
mesh_terms: D000328:Adult; D000368:Aged; D003627:Data Interpretation, Statistical; D005260:Female; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009593:Nitroimidazoles; D030361:Papillomavirus Infections / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals
chemical_list: D009593:Nitroimidazoles; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; C498052:fluoroazomycin arabinoside
keywords: Head and neck cancer; Hypoxia; PET; Radiation therapy