Zegers Catharina M L, van Elmpt Wouter, Hoebers Frank J P, Troost Esther G C, Öllers Michel C, Mottaghy Felix M, Lambin Philippe
a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands.
b Helmholtz Zentrum Dresden-Rossendorf , Dresden , Germany.
Acta Oncol. 2015;54(9):1378-84. doi: 10.3109/0284186X.2015.1062913. Epub 2015 Jul 27.
Tumour hypoxia and a high tumour metabolism increase radioresistance in patients with head and neck squamous cell carcinoma (HNSCC). The aim of this study was to evaluate the correlation between hypoxia ([(18)F]HX4 PET) and glucose metabolism ([(18)F]FDG PET) molecular imaging.
[(18)F]HX4 and [(18)F]FDG PET/CT images of 20 HNSCC patients were acquired prior to (chemo)radiotherapy, in an immobilisation mask, with a median time interval of seven days (NCT01347281). Gross tumour volumes of the primary lesions (GTVprim) and pathological lymph nodes (GTVln) were included in the analysis. [(18)F]FDG PET/CT images were rigidly registered to the [(18)F]HX4 PET/CT images. The maximum and mean standardised uptake values (SUVmax, SUVmean) within both GTVs were determined. In addition, the overlap was compared between the [(18)F]HX4 high volume ([(18)F]HX4 HV) with a tumour-to-muscle ratio > 1.4 and the [(18)F]FDG high volume ([(18)F]FDG HV) with an SUV > 50% of the SUVmax. We report the mean ± standard deviation.
PET/CT scans including 20 GTVprim and 12 GTVln were analysed. There was a significant correlation between several [(18)F]FDG and [(18)F]HX4 parameters, the most pronounced being the correlation between [(18)F]FDG HV and [(18)F]HX4 HV (R = 0.93, p < 0.001). The fraction of the GTVprim with a high HX4 uptake (9 ± 10%) was on average smaller than the FDG high fraction (51 ± 26%; p < 0.001). In 65% (13/20) of the patients, the GTVprim was hypoxic. In four of these patients the [(18)F]HX4 HV was located within the [(18)F]FDG HV, whereas for the remaining nine GTVprim a partial mismatch was observed. In these nine tumours 25 ± 21% (range 5-64%) of the HX4 HV was located outside the FDG HV.
There is a correlation between [(18)F]HX4 and [(18)F]FDG uptake parameters on a global tumour level. In the majority of lesions a partial mismatch between the [(18)F]HX4 and [(18)F]FDG high uptake volumes was observed, therefore [(18)F]FDG PET imaging cannot be used as a surrogate for hypoxia. [(18)F]HX4 PET provides complementary information to [(18)F]FDG PET imaging.
肿瘤缺氧和高肿瘤代谢会增加头颈部鳞状细胞癌（HNSCC）患者的放射抗性。本研究的目的是评估缺氧（[（18）F]HX4 PET）与葡萄糖代谢（[（18）F]FDG PET）分子成像之间的相关性。
在（化疗）放疗前，使用固定面罩对20例HNSCC患者进行[（18）F]HX4和[（18）F]FDG PET/CT成像，中位时间间隔为7天（NCT01347281）。分析原发灶（GTVprim）和病理淋巴结（GTVln）的大体肿瘤体积。将[（18）F]FDG PET/CT图像与[（18）F]HX4 PET/CT图像进行刚性配准。确定两个GTV内的最大和平均标准化摄取值（SUVmax、SUVmean）。此外，比较肿瘤与肌肉比值>1.4的[（18）F]HX4高体积（[（18）F]HX4 HV）与SUV>SUVmax的50%的[（18）F]FDG高体积（[（18）F]FDG HV）之间的重叠情况。我们报告平均值±标准差。
分析了包括20个GTVprim和12个GTVln的PET/CT扫描。几个[（18）F]FDG和[（18）F]HX4参数之间存在显著相关性，最显著的是[（18）F]FDG HV与[（18）F]HX4 HV之间的相关性（R = 0.93，p < 0.001）。HX4摄取高的GTVprim部分平均（9±10%）小于FDG高摄取部分（51±26%；p < 0.001）。65%（13/20）的患者GTVprim存在缺氧。其中4例患者的[（18）F]HX4 HV位于[（18）F]FDG HV内，而其余9个GTVprim观察到部分不匹配。在这9个肿瘤中，25±21%（范围5 - 64%）的HX4 HV位于FDG HV之外。
在整体肿瘤水平上，[（18）F]HX4与[（18）F]FDG摄取参数之间存在相关性。在大多数病变中，观察到[（18）F]HX4与[（18）F]FDG高摄取体积之间存在部分不匹配，因此[（18）F]FDG PET成像不能用作缺氧的替代指标。[（18）F]HX4 PET为[（18）F]FDG PET成像提供了补充信息。
