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Utility of FMISO PET in advanced head and neck cancer treated with chemoradiation incorporating a hypoxia-targeting chemotherapy agent
Authors:Rodney J Hicks  Danny Rischin  Richard Fisher  David Binns  Andrew M Scott  Lester J Peters
Institution:(1) Centre for Molecular Imaging, Peter MacCallum Cancer Centre, Locked Bag No 1, ArsquoBeckett St., Melbourne, 8006, Australia;(2) Department of Medicine, St Vincentrsquos Medical School, University of Melbourne, Melbourne, Australia;(3) Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia;(4) Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia;(5) Centre for PET, and Ludwig Institute for Cancer Research, Austin Hospital, Melbourne, Australia;(6) Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
Abstract:Purpose The purpose of the study was to evaluate 18F]fluoromisonidazole (FMISO) PET in advanced head and neck cancer during hypoxia-targeting therapy.Methods Fifteen of 16 patients in a phase I trial of chemoradiation plus tirapazamine (specific cytotoxin for hypoxic cells) in advanced (T3/4 and/or N2/3) head and neck cancer underwent serial 18F]fluorodeoxyglucose (FDG) and FMISO PET. We have previously reported excellent early clinical outcome of these patients and now review FMISO PET results in the context of longer follow-up of this patient cohort.Results Based on blinded qualitative scoring by two readers, FMISO PET was positive in 13/15 patients at baseline: 12/15 of primary sites and 8/13 neck nodes were scored as positive. All sites of corresponding FDG and FMISO abnormality at baseline showed marked qualitative reduction of uptake within 4 weeks of commencing therapy, consistent with effective hypoxia-targeted therapy. With a median follow-up of 6.9 years, there have been only four locoregional failures, while three other patients have died of metachronous lung cancer. The 5-year overall survival was 50% (95% CI 27–73%), the 5-year failure-free survival was 44% (95% CI 22–68%) and the 5-year freedom from locoregional failure was 68% (95% CI 38–88%).Conclusion The high prevalence of hypoxia demonstrated on FMISO PET imaging is consistent with the advanced disease stage of these patients and would be expected to predict an adverse prognosis. Evidence of the early resolution of FMISO abnormality during treatment, associated with excellent locoregional control in this patient cohort, supports further investigation of hypoxia-targeting agents in advanced head and neck cancer.
Keywords:PET  Advanced head and neck cancer  Chemoradiotherapy  Hypoxia
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