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Imaging, Diagnosis, Prognosis |
Authors' Affiliations: Departments of 1 Radiology and 2 Radiation Oncology, University of Washington; 3 Department of Radiation Oncology, Veterans' Administration Puget Sound Health Care System, Seattle, Washington; and 4 University College, Cork, Cork, Ireland
Requests for reprints: Joseph Rajendran, Division of Nuclear Medicine, University of Washington, Box 356113, 1959 Pacific Street, Seattle, WA 98195. Phone: 206-598-4240; Fax: 206-598-3681; E-mail: rajan{at}u.washington.edu.
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.
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