Serial [18F]-fluoromisonidazole PET during radiochemotherapy for locally advanced head and neck cancer and its correlation with outcome

Radiother Oncol. 2015 Oct;117(1):113-7. doi: 10.1016/j.radonc.2015.09.015. Epub 2015 Sep 29.


Purpose: The aim was to assess changes of tumour hypoxia during primary radiochemotherapy (RCT) for head and neck cancer (HNC) and to evaluate their relationship with treatment outcome.

Material and methods: Hypoxia was assessed by FMISO-PET in weeks 0, 2 and 5 of RCT. The tumour volume (TV) was determined using FDG-PET/MRI/CT co-registered images. The level of hypoxia was quantified on FMISO-PET as TBRmax (SUVmaxTV/SUVmean background). The hypoxic subvolume (HSV) was defined as TV that showed FMISO uptake ⩾1.4 times blood pool activity.

Results: Sixteen consecutive patients (T3-4, N+, M0) were included (mean follow-up 31, median 44months). Mean TBRmax decreased significantly (p<0.05) from 1.94 to 1.57 (week 2) and 1.27 (week 5). Mean HSV in week 2 and week 5 (HSV2=5.8ml, HSV3=0.3ml) were significantly (p<0.05) smaller than at baseline (HSV1=15.8ml). Kaplan-Meier plots of local recurrence free survival stratified at the median TBRmax showed superior local control for less hypoxic tumours, the difference being significant at baseline and after 2weeks (p=0.031, p=0.016).

Conclusions: FMISO-PET documented that in most HNC reoxygenation starts early during RCT and is correlated with better outcome.

Keywords: 18F-MISO; Head and neck cancer; Hypoxia; PET; Radiochemotherapy.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / complications
  • Carcinoma, Squamous Cell / diagnostic imaging*
  • Carcinoma, Squamous Cell / therapy
  • Chemoradiotherapy
  • Feasibility Studies
  • Female
  • Fluorine Radioisotopes
  • Head and Neck Neoplasms / complications
  • Head and Neck Neoplasms / diagnostic imaging*
  • Head and Neck Neoplasms / therapy
  • Humans
  • Hypoxia / diagnostic imaging
  • Hypoxia / etiology
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Misonidazole / analogs & derivatives
  • Positron-Emission Tomography / methods
  • Treatment Outcome
  • Tumor Burden


  • Fluorine Radioisotopes
  • fluoromisonidazole
  • Misonidazole