Generation of biological hypotheses by functional imaging links tumor hypoxia to radiation induced tissue inflammation/glucose uptake in head and neck cancer

•PET measured tumor hypoxia is inversely correlated with PET measured glucose uptake of tumor surroundings especially during radiotherapy.•Both parameters bear great prognostic value.•The prognostic accuracy can be improved when both parameters are combined.•PET examinations during radiotherapy can...

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Bibliographic Details
Published in:Radiotherapy and oncology 2021-02, Vol.155, p.204-211
Main Authors: Zschaeck, Sebastian, Zöphel, Klaus, Seidlitz, Annekatrin, Zips, Daniel, Kotzerke, Jörg, Baumann, Michael, Troost, Esther G.C., Löck, Steffen, Krause, Mechthild
Format: Article
Language:English
Subjects:
Cell Hypoxia
FDG PET
Fluorodeoxyglucose F18
FMISO PET
Glucose
Head and neck cancer
Head and Neck Neoplasms - diagnostic imaging
Head and Neck Neoplasms - radiotherapy
Humans
Hypoxia
Inflammation
Inflammation - diagnostic imaging
Misonidazole
Positron-Emission Tomography
Prospective Studies
Radiopharmaceuticals
Radiotherapy
Tumor Hypoxia
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Summary:•PET measured tumor hypoxia is inversely correlated with PET measured glucose uptake of tumor surroundings especially during radiotherapy.•Both parameters bear great prognostic value.•The prognostic accuracy can be improved when both parameters are combined.•PET examinations during radiotherapy can unravel complex tumor-host interactions. Positron emission tomography (PET) is a functional imaging modality which is able to deliver tracer specific biological information, e.g. about glucose uptake, inflammation or hypoxia of tumors. We performed a proof-of-principle study that used different tracers and expanded the analytical scope to non-tumor structures to evaluate tumor-host interactions. Based on a previously reported prospective imaging study on 50 patients treated with curative intent chemoradiation (CRT) for head and neck squamous cell carcinoma, PET-based hypoxia and normal tissue inflammation measured by repeat 18F-fluoromisonidazole (FMISO) PET and 18F-fluorodesoxyglucose (FDG) PET, respectively, were correlated using the Spearman correlation coefficient R. PET parameters determined before and during CRT (week 1, 2 and 5), were associated with local tumor control and overall survival. Tumor hypoxia at all measured times showed an inverse correlation with mid-treatment FDG-uptake of non-tumor affected oral (sub-)mucosa with R values between −0.35 and −0.6 (all p 
ISSN:0167-8140
1879-0887
DOI:10.1016/j.radonc.2020.10.030