18F-fluoromisonidazole positron emission tomography before treatment is a predictor of radiotherapy outcome and survival prognosis in patients with head and neck squamous cell carcinoma

Abstract

To evaluate the usefulness of [(18)F]fluoromisonidazole ([(18)F]FMISO)-positron emission tomography (PET) prior to the treatment of head and neck squamous cell carcinoma. Seventeen patients with untreated HNSCC underwent pretreatment [(18)F]FMISO PET. Six of them underwent definitive surgery and the remaining 11 definitive (chemo-)radiotherapy. We evaluated 30 lesions from the 17 patients. SUVmax and tumor-to-muscle ratios (TMR) were measured as hypoxia indicators. Tumors equal to or above the median value were defined as tumor with high uptake of [(18)F]FMISO and those below as tumor with low uptake of [(18)F]FMISO in both indicators. Local control rates with radiotherapy, event-free survival and disease-specific survival (DSS) rates with radiotherapy or operation were compared. [(18)F]FMISO-PET imaging of 30 lesions resulted in a SUVmax median value of 2.3 and a TMR median value of 1.3. Local control rates with radiotherapy (20-month median follow-up duration) were significantly lower in the tumor group with high uptake of [(18)F]FMISO compared to the tumor group with low uptake of [(18)F]FMISO using either SUVmax or TMR as the hypoxic indicator (P = 0.02 and 0.04, respectively). DSS rate with radiotherapy or operation (21-month median follow-up duration) was significantly lower in the patient group with high uptake of [(18)F]FMISO compared to the patient group with low uptake of [(18)F]FMISO defined by SUVmax (P = 0.04), but was not by TMR (P = 0.57). Radiotherapy outcome and survival prognosis (radiotherapy or operation) in HNSCC may be predicted by carrying out [(18)F]FMISO PET before treatment.