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A prospective clinical study of 18 F-FAZA PET-CT hypoxia imaging in head and neck squamous cell carcinoma before and during radiation therapy

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Abstract

Purpose

Hypoxia in head and neck squamous cell carcinoma (HNSCC) is associated with poor prognosis and outcome. 18 F-Fluoroazomycin arabinoside (FAZA) is a positron emission tomography (PET) tracer developed to enable identification of hypoxic regions within tumor. The aim of this study was to evaluate the use of 18 F-FAZA-PET for assessment of hypoxia before and during radiation therapy.

Methods

Twelve patients with locally advanced HNSCC underwent 18 F-FAZA-PET scans before and at fraction 7 and 17 of concomitant chemo-radiotherapy. A hypoxic voxel was defined as a voxel expressing a standardized uptake value (SUV) equal or above the SUVmean of the posterior contralateral neck muscles plus three standard deviations. The fractional hypoxic volume fraction (FHV) and the spatial move of hypoxic volumes during treatment were analyzed.

Results

A hypoxic volume could be identified in ten patients before treatment. FAZA-PET FHV varied from 0 to 54.3 % and from 0 to 41.4 % in the primary tumor and in the involved node, respectively. Six out of these ten patients completed all the FAZA-PET-computed tomography (CT) during the radiotherapy. In all patients, FHV and SUVmax values decreased. All patient presented a spatial move of hypoxic volume, but only three patients had newborn hypoxic voxels after 17 fractions.

Conclusion

This study indicated that 18 F-FAZA-PET could be used to identify and quantify tumor hypoxia before and during concomitant radio-chemotherapy in patients with locally advanced HNSCC. In addition to the information on prognostic value, the use of 18 F-FAZA-PET allowed the delineation of hypoxic volumes for dose escalation protocols. However, due to fluctuation of hypoxia during treatment, repeated scan will have to be performed (i.e. adaptive radiotherapy).

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Conflict of interest

The authors declare that they have no conflict of interest.

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Author notes

  1. Stéphanie Servagi-Vernat

    Present address: Department of Radiation Oncology, University Hospital Jean Minjoz, Boulevard Fleming, F-25000, Besancon, France

Authors and Affiliations

  1. Department of Radiation Oncology and Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Institut de Recherche Clinique (IREC), Université catholique de Louvain, St-Luc University Hospital, Brussels, Belgium

    Stéphanie Servagi-Vernat, Sarah Differding, Daniel Labar, Anne Bol, John A. Lee & Vincent Grégoire

  2. Department of Nuclear Medicine and Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Institut de Recherche Clinique (IREC), Université catholique de Louvain, St-Luc University Hospital, Brussels, Belgium

    Francois-Xavier Hanin

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  1. Stéphanie Servagi-Vernat
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Correspondence to Stéphanie Servagi-Vernat.

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Servagi-Vernat, S., Differding, S., Hanin, FX. et al. A prospective clinical study of 18 F-FAZA PET-CT hypoxia imaging in head and neck squamous cell carcinoma before and during radiation therapy. Eur J Nucl Med Mol Imaging 41, 1544–1552 (2014). https://doi.org/10.1007/s00259-014-2730-x

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  • DOI: https://doi.org/10.1007/s00259-014-2730-x

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