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Dose painting in radiotherapy for head and neck squamous cell carcinoma: value of repeated functional imaging with 18F-FDG PET, 18F-fluoromisonidazole PET, diffusion-weighted MRI, and dynamic contrast-enhanced MRI
The Journal of Nuclear Medicine, 06/15/09

Dirix P et al. - In a study to evaluate the potential of functional imaging with 18F-FDG PET, 18F-fluoromisonidazole PET, diffusion-weighted MRI, and dynamic contrast-enhanced MRI to provide an appropriate and reliable biologic target for dose painting in radiotherapy for head and neck squamous cell carcinoma (HNSCC), the results confirm the added value of 18F-FDG PET and 18F-fluoromisonidazole PET for radiotherapy planning of HNSCC and suggest the potential of diffusion-weighted and dynamic enhanced MRI for dose painting and early response assessment.

Methods

15 pts with locally advanced HNSCC, treated with concomitant chemoradiotherapy, were prospectively enrolled in a bioimaging protocol.
Sequential PET (18F-FDG and 18F-fluoromisonidazole) and MRI (T1, T2, dynamic enhanced, and diffusion-weighted sequences) were performed before, during, and after radiotherapy.

Results

Median follow-up was 30.7 mo; in 7 pts, disease recurred.
Disease-free survival correlated negatively with the maximum tissue-to-blood 18F-fluoromisonidazole ratio (T/Bmax) on the baseline 18F-fluoromisonidazole scan, with size of the initial hypoxic volume, and with T/Bmax on the 18F-fluoromisonidazole scan during treatment.
All locoregional recurrences were within the 18F-FDG–avid regions on baseline 18F-FDG PET; 3 recurrences mapped outside the hypoxic volume on baseline 18F-fluoromisonidazole PET.
Lesions (primary tumor and lymph nodes) where a locoregional recurrence developed during follow-up had significantly lower apparent diffusion coefficients on diffusion-weighted MRI during wk 4 of radiotherapy (0.0013 vs 0.0018 mm2/s) and at 3 wk after treatment (0.0014 vs 0.0018 mm2/s) and a significantly higher initial slope on baseline dynamic enhanced MRI (26.2 vs 17.5/s) than did lesions that remained controlled.

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