Exploratory geographical analysis of hypoxic subvolumes using 18F-MISO-PET imaging in patients with head and neck cancer in the course of primary chemoradiotherapy

Radiother Oncol. 2013 Sep;108(3):511-6. doi: 10.1016/j.radonc.2013.06.012. Epub 2013 Jul 10.


Background and purpose: Hypoxia in head and neck tumours is associated with poor prognosis and outcome, and can be visualized using (18)F-MISO-PET imaging; however, it is not clear whether the size and location of hypoxic subvolumes remain stable during therapy. In a pilot project, we conducted an exploratory analysis of persistent tumour hypoxia during treatment.

Materials and methods: Sixteen patients with locally advanced head and neck tumours underwent consecutive (18)F-MISO-PET scans before and during primary chemoradiotherapy. The size, location and overlap of the hypoxic subvolumes were analysed using a semi-automatic algorithm based on a tumour to normal tissue ratio of 1.5.

Results: Quantitative evaluation showed tumour hypoxia in week 0 in 16 out of 16 and in week 2 in 5 out of 14 patients. For the five patients with persistent hypoxia, both increased and decreased hypoxic subvolumes could be observed. Mean hypoxic subvolume overlap was 55% of the hypoxic volume of the first scan and 72% of the hypoxic volume of the second scan. A stationary (in four out of five patients) and dynamic component (in three out of five patients) could be differentiated.

Conclusion: In patients with persistent hypoxia after 2 weeks of treatment, the hypoxic subvolumes showed mostly a geographically relatively stable conformation.

Keywords: Biological imaging; Head and neck tumours; Hypoxia imaging; PET; Tumour hypoxia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cell Hypoxia
  • Chemoradiotherapy*
  • Female
  • Fluorine Radioisotopes*
  • Head and Neck Neoplasms / diagnostic imaging
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / therapy*
  • Humans
  • Male
  • Misonidazole / analogs & derivatives*
  • Pilot Projects
  • Positron-Emission Tomography / methods*
  • Radiopharmaceuticals*


  • Fluorine Radioisotopes
  • Radiopharmaceuticals
  • fluoromisonidazole
  • Misonidazole