Hypoxia-imaging with 18F-misonidazole and PET:: Changes of kinetics during radiotherapy of head-and-neck cancer

Background and purpose: PET with 18 F-Misonidazole (FMISO-PET) is a non-invasive method for measuring tumor hypoxia. We analysed changes of FMISO-uptake during radiotherapy and their impact on patient outcome. Materials and methods: Fourteen patients with HNC underwent repeated FMISO-PET prior to radiotherapy and after 30 Gy. Dynamic and static PET-scans (2 + 4 h p.i.) were acquired. FMISO-uptake was quantified by calculating standard uptake values (SUV) and tu mor-muscle-ratios (TMR). Kinetic curve types representing tissue hypoxia were defined. Change of curve type was correlated with patient outcome. Results: The mean SUV 4 h p.i. and the TMR decreased significantly during radiotherapy. SUV decreased clearly in 12/ 14 patients, and increased in 2 patients. TMR decreased in 11 patients, and increased in 3 patients. Prior to radiotherapy, three different shapes of kinetic curve types indicative for the degree of hypoxia could be defined in 12/ 14 patients: (1) accumulation type (severe hypoxia (n = 8)), (2) intermediate type (intermediate degree of hypoxia (n = 3)), and (3) wash-out type (low degree of hypoxia (n = 1)). Curve type changed towards a lower degree of hypoxia at 30 Gy in all but 3 patients. In three patients curve type remained unchanged. Conclusions: The changes in tumor FMISO-uptake during radiotherapy indicate radio-induced reoxygenation. (C) 2007 Elsevier Ireland Ltd. AU rights reserved.