Kinetic analysis of dynamic 18F-fluoromisonidazole PET correlates with radiation treatment outcome in head-and-neck cancer

Abstract

BackgroundHypoxia compromises local control in patients with head-and-neck cancer (HNC). In order to determine the value of [18F]-fluoromisonidazole (Fmiso) with regard to tumor hypoxia, a patient study with dynamic Fmiso PET was performed. For a better understanding of tracer uptake and distribution, a kinetic model was developed to analyze dynamic Fmiso PET data.MethodsFor 15 HNC patients, dynamic Fmiso PET examinations were performed prior to radiotherapy (RT) treatment. The data was analyzed using a two compartment model, which allows the determination of characteristic hypoxia and perfusion values. For different parameters, such as patient age, tumor size and standardized uptake value, the correlation to treatment outcome was tested using the Wilcoxon-Mann-Whitney U-test. Statistical tests were also performed for hypoxia and perfusion parameters determined by the kinetic model and for two different metrics based on these parameters.ResultsThe kinetic Fmiso analysis extracts local hypoxia and perfusion characteristics of a tumor tissue. These parameters are independent quantities. In this study, different types of characteristic hypoxia-perfusion patterns in tumors could be identified.The clinical verification of the results, obtained on the basis of the kinetic analysis, showed a high correlation of hypoxia-perfusion patterns and RT treatment outcome (p = 0.001) for this initial patient group.ConclusionThe presented study established, that Fmiso PET scans may benefit from dynamic acquisition and analysis by a kinetic model. The pattern of distribution of perfusion and hypoxia in the tissue is correlated to local control in HNC.

Prediction of Disease-Free Survival in Patients with Squamous Cell Carcinomas of the Head and Neck Using Dynamic Contrast-Enhanced MR Imaging

“…28 On the other hand, hypoxia (decreased blood flow) enhances chemoresistance and impedes delivery of therapeutic agents. 29 However, the relationship between HNSCC perfusion and hypoxia may be complex as recently described by several investigators 30,31 who used dynamic [ 18 F]luoromisonidazole PET to assess the perfusion of the primary tumor while simultaneously assessing tumor hypoxia through misonidazole binding. These investigators demonstrated that HNSCC tumors might have significant heterogeneous regions characterized by various perfusion-oxygenation relationships.…”

Fluorine-18-Labeled Fluoromisonidazole Positron Emission and Computed Tomography-Guided Intensity-Modulated Radiotherapy for Head and Neck Cancer: A Feasibility Study

“…First, the treatment plans were done using on a single 18 F-FMISO PET scan performed at ∼2.5 h after injection. Studies by others (72,73) have shown potential limitations with single time point imaging and have proposed a dynamic scanning approach. In the latter method, the kinetic information of the tracer uptake and retention behavior in each PET image voxel is used to generate parametric maps of putative hypoxia tracer trapping using compartmental models of the tracer binding chemistry (71,72).…”

Positron emission tomography to assess hypoxia and perfusion in lung cancer

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