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

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/blood(max) (T/B-max) 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/B-max (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/B-max (or HV) were both highly predictive (P = 0.02, 0.006 for node and T/B-max, 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.