FMISO-PET-based lymph node hypoxia adds to the prognostic value of tumor only hypoxia in HNSCC patients. (January 2019)

• Record Type: Journal Article
• Authors: Bandurska-Luque, Anna; Löck, Steffen; Haase, Robert; Richter, Christian; Zöphel, Klaus; Abolmaali, Nasreddin; Seidlitz, Annekatrin; Appold, Steffen; Krause, Mechthild; Steinbach, Jörg; Kotzerke, Jörg; Zips, Daniel; Baumann, Michael; Troost, Esther G.C.
• Is Part Of: Radiotherapy and oncology. Volume 130(2019)
• Page Start: 97
• Page End: 103
• Publication Date: 2019-01
• Subjects: Hypoxia -- FMISO-PET -- Lymph node -- Locally advanced HNSCC -- Prognostic biomarker; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2018.09.008
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: Secondary analysis of largest FMISO-PET/CT study focusing on lymph node hypoxia. Synchronous tumor and lymph node hypoxia correlates with loco-regional failure. Quantitative lymph node hypoxia correlates with regional control. Abstract: Purpose: This secondary analysis of the prospective study on repeat [ 18 F]fluoromisonidazole (FMISO)-PET in patients with locally advanced head and neck squamous cell carcinomas (HNSCC) assessed the prognostic value of synchronous hypoxia in primary tumor (Tu) and lymph node metastases (LN), and evaluated whether the combined reading was of higher prognostic value than that of primary tumor hypoxia only. Methods: This analysis included forty-five LN-positive HNSCC patients. FMISO-PET/CTs were performed at baseline, weeks 1, 2 and 5 of radiochemotherapy. Based on a binary scale, Tu and LN were categorized as hypoxic or normoxic, and two prognostic parameters were defined: Tu-hypoxia (independent of the LN oxygenation status) and synchronous Tu-and-LN-hypoxia. In fifteen patients with large LN ( N = 21), additional quantitative analyses of FMISO-PET/CTs were performed. Imaging parameters at different time-points were correlated to the endpoints, i.e., locoregional control (LRC), local control (LC), regional control (RC) and time to progression (TTP). Survival curves were estimated using the cumulative incidence function. Univariable and multivariable Cox regression was used to evaluate the prognostic impact of hypoxia on the endpoints. Results: Synchronous Tu-and-LN-hypoxia was a strong adverse prognostic factor for LC, LRC and TTP at any of the four time-points ( p ≤ 0.004), whereas Tu-hypoxia only was significantly associated with poor LC and LRC in weeks 2 and 5 ( p ≤ 0.047), and with TTP in week 1 ( p = 0.046). The multivariable analysis confirmed the prognostic value of synchronous Tu-and-LN-hypoxia regarding LRC (HR = 14.8, p = 0.017). The quantitative FMISO-PET/CT parameters correlated with qualitative hypoxia scale and RC ( p < 0.001, p ≤ 0.033 at week 2, respectively). Conclusions: This secondary analysis suggests that combined reading of primary tumor and LN hypoxia adds to the prognostic information of FMSIO-PET in comparison to primary tumor assessment alone in particular prior and early during radiochemotherapy. Confirmation in ongoing trials is needed before using this marker for personalized radiation oncology.