Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2006 Sep 15;12(18):5435-41.
doi: 10.1158/1078-0432.CCR-05-1773.

Tumor hypoxia imaging with [F-18] fluoromisonidazole positron emission tomography in head and neck cancer

Joseph G Rajendran  1 , David L Schwartz, Janet O'Sullivan, Lanell M Peterson, Patrick Ng, Jeffrey Scharnhorst, John R Grierson, Kenneth A Krohn
Affiliations
Comparative Study

Tumor hypoxia imaging with [F-18] fluoromisonidazole positron emission tomography in head and neck cancer

Joseph G Rajendran et al. Clin Cancer Res. .

Abstract

Purpose: 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.

Experimental design: 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.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
FMISO and FDG-PET images (coronal) of a 70-year-old patient with a primary piriform sinus squamous cell carcinoma (solid arrow) with metastatic lymph nodes (open arrows).T/Bmax is 1.5. HV is 6.44 mL for the primary tumor.
Fig. 2
Fig. 2
Kaplan-Meier overall survival curve when patients are classified by the presence of nodes. High risk (n = 46) is defined as having N2 or N3 disease.
Fig. 3
Fig. 3
Kaplan-Meier overall survival curve when patients are classified byT/Bmax. High T/Bmax is defined as patients whose T/Bmax is above the median of 1.5.
Fig. 4
Fig. 4
Kaplan-Meier overall survival curve when patients are classified by FDG uptake. High FDG is defined as patients whose FDG uptake is above the median SUVmax of 10.4.
See this image and copyright information in PMC

Comment in

  • Tumor hypoxia imaging.
    Serganova I, Humm J, Ling C, Blasberg R. Serganova I, et al. Clin Cancer Res. 2006 Sep 15;12(18):5260-4. doi: 10.1158/1078-0432.CCR-06-0517. Clin Cancer Res. 2006. PMID: 17000656 Review. No abstract available.

References

    1. Adam M, Gabalski EC, Bloch DA, et al. Tissue oxygen distribution in head and neck cancer patients. Head Neck. 1999;21:146–53. - PubMed
    1. Rasey JS, Koh WJ, Evans ML, et al. Quantifying regional hypoxia in human tumors with positron emission tomography of [18F]fluoromisonidazole: a pre-therapy study of 37 patients. Int J Radiat Oncol Biol Phys. 1996;36:417–28. - PubMed
    1. Brizel DM, Sibley GS, Prosnitz LR, Scher RL, Dewhirst MW. Tumor hypoxia adversely affects the prognosis of carcinoma of the head and neck. Int J Radiat Oncol Biol Phys. 1997;38:285–9. - PubMed
    1. Hockel M, Schlenger K, Knoop C, Vaupel P. Oxygenation of carcinoma of the uterine cervix: evaluation by computerized oxygen tension measurements. Cancer Res. 1991;51:6098–102. - PubMed
    1. Rajendran JG, Wilson DC, Conrad EU, et al. [(18)F]FMISO and [(18)F]FDG PET imaging in soft tissue sarcomas: correlation of hypoxia, metabolism and VEGF expression. Eur J Nucl Med Mol Imaging. 2003;30:695–704. - PubMed

Publication types