Prospective trial incorporating pre-/mid-treatment [18F]-misonidazole positron emission tomography for head-and-neck cancer patients undergoing concurrent chemoradiotherapy

Int J Radiat Oncol Biol Phys. 2009 Sep 1;75(1):101-8. doi: 10.1016/j.ijrobp.2008.10.049. Epub 2009 Feb 7.


Purpose: To report the results from a prospective study of a series of locoregionally advanced head-and-neck cancer patients treated with platinum-based chemotherapy and intensity-modulated radiotherapy and to discuss the findings of their pre-/mid-treatment [(18)F]-misonidazole ((18)F-FMISO) positron emission tomography (PET) scans.

Methods and materials: A total of 28 patients agreed to participate in this study. Of these 28 patients, 20 (90% with an oropharyngeal primary cancer) were able to undergo the requirements of the protocol. Each patient underwent four PET scans: one pretreatment fluorodeoxyglucose PET/computed tomography scan, two pretreatment (18)F-FMISO PET/computed tomography scans, and a third (18)F-FMISO PET (mid-treatment) scan performed 4 weeks after the start of chemoradiotherapy. The (18)F-FMISO PET scans were acquired 2-3 h after tracer administration. Patients were treated with 2-3 cycles of platinum-based chemotherapy concurrent with definitive intensity-modulated radiotherapy.

Results: A heterogeneous distribution of (18)F-FMISO was noted in the primary and/or nodal disease in 90% of the patients. Two patients had persistent detectable hypoxia on their third mid-treatment (18)F-FMISO PET scan. One patient experienced regional/distant failure but had no detectable residual hypoxia on the mid-treatment (18)F-FMISO PET scan.

Conclusion: Excellent locoregional control was observed in this series of head-and-neck cancer patients treated with concurrent platinum-based chemotherapy and intensity-modulated radiotherapy despite evidence of detectable hypoxia on the pretreatment (18)F-FMISO PET/computed tomography scans of 18 of 20 patients. In this prospective study, neither the presence nor the absence of hypoxia, as defined by positive (18)F-FMISO findings on the mid-treatment PET scan, correlated with patient outcome. The results of this study have confirmed similar results reported previously.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Carboplatin / administration & dosage
  • Cell Hypoxia / drug effects*
  • Cisplatin / administration & dosage
  • Combined Modality Therapy / methods
  • Fluorouracil / administration & dosage
  • Humans
  • Laryngeal Neoplasms / diagnostic imaging*
  • Laryngeal Neoplasms / drug therapy
  • Laryngeal Neoplasms / metabolism
  • Laryngeal Neoplasms / radiotherapy
  • Middle Aged
  • Misonidazole / analogs & derivatives*
  • Misonidazole / pharmacokinetics
  • Oropharyngeal Neoplasms / diagnostic imaging
  • Oropharyngeal Neoplasms / drug therapy
  • Oropharyngeal Neoplasms / metabolism
  • Oropharyngeal Neoplasms / radiotherapy
  • Positron-Emission Tomography / methods*
  • Prospective Studies
  • Radiopharmaceuticals* / pharmacokinetics
  • Radiotherapy Dosage
  • Radiotherapy, Intensity-Modulated / methods*
  • Tomography, X-Ray Computed
  • Tumor Burden


  • Radiopharmaceuticals
  • fluoromisonidazole
  • Misonidazole
  • Carboplatin
  • Cisplatin
  • Fluorouracil