Fluorine-18-Labeled Fluoromisonidazole Positron Emission and Computed Tomography-Guided Intensity-Modulated Radiotherapy for Head and Neck Cancer: A Feasibility Study Journal Article


Authors: Lee, N. Y.; Mechalakos, J. G.; Nehmeh, S.; Lin, Z.; Squire, O. D.; Cai, S.; Chan, K.; Zanzonico, P. B.; Greco, C.; Ling, C. C.; Humm, J. L.; Schoder, H.
Article Title: Fluorine-18-Labeled Fluoromisonidazole Positron Emission and Computed Tomography-Guided Intensity-Modulated Radiotherapy for Head and Neck Cancer: A Feasibility Study
Abstract: Purpose: Hypoxia renders tumor cells radioresistant, limiting locoregional control from radiotherapy (RT). Intensity-modulated RT (IMRT) allows for targeting of the gross tumor volume (GTV) and can potentially deliver a greater dose to hypoxic subvolumes (GTVh) while sparing normal tissues. A Monte Carlo model has shown that boosting the GTVh increases the tumor control probability. This study examined the feasibility of fluorine-18-labeled fluoromisonidazole positron emission tomography/computed tomography (18F-FMISO PET/CT)-guided IMRT with the goal of maximally escalating the dose to radioresistant hypoxic zones in a cohort of head and neck cancer (HNC) patients. Methods and Materials: 18F-FMISO was administered intravenously for PET imaging. The CT simulation, fluorodeoxyglucose PET/CT, and 18F-FMISO PET/CT scans were co-registered using the same immobilization methods. The tumor boundaries were defined by clinical examination and available imaging studies, including fluorodeoxyglucose PET/CT. Regions of elevated 18F-FMISO uptake within the fluorodeoxyglucose PET/CT GTV were targeted for an IMRT boost. Additional targets and/or normal structures were contoured or transferred to treatment planning to generate 18F-FMISO PET/CT-guided IMRT plans. Results: The heterogeneous distribution of 18F-FMISO within the GTV demonstrated variable levels of hypoxia within the tumor. Plans directed at performing 18F-FMISO PET/CT-guided IMRT for 10 HNC patients achieved 84 Gy to the GTVh and 70 Gy to the GTV, without exceeding the normal tissue tolerance. We also attempted to deliver 105 Gy to the GTVh for 2 patients and were successful in 1, with normal tissue sparing. Conclusion: It was feasible to dose escalate the GTVh to 84 Gy in all 10 patients and in 1 patient to 105 Gy without exceeding the normal tissue tolerance. This information has provided important data for subsequent hypoxia-guided IMRT trials with the goal of further improving locoregional control in HNC patients. © 2008 Elsevier Inc. All rights reserved.
Keywords: adult; clinical article; treatment outcome; middle aged; intensity modulated radiation therapy; cancer radiotherapy; radiation dose; positron emission tomography; cancer diagnosis; prospective studies; radiopharmaceuticals; computer assisted tomography; radiotherapy dosage; radiotherapy; tomography, x-ray computed; drug synthesis; oncology; hypoxia; feasibility study; drug distribution; head and neck cancer; intensity-modulated radiotherapy; computerized tomography; tumors; feasibility studies; head and neck neoplasms; radiotherapy, intensity-modulated; fluorodeoxyglucose f 18; fluorodeoxyglucose f18; positron-emission tomography; 1 fluoro 3 (2 nitro 1 imidazolyl) 2 propanol f 18; cell hypoxia; misonidazole; radiation-sensitizing agents; 18f-fmiso; intensity modulated radiotherapy; fluorine-18-labeled fluoromisonidazole; monte carlo methods; fluorine-18 labeled fluoromisonidazole
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 70
Issue: 1
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2008-01-01
Start Page: 2
End Page: 13
Language: English
DOI: 10.1016/j.ijrobp.2007.06.039
PUBMED: 17869020
PROVIDER: scopus
PMCID: PMC2888477
DOI/URL:
Notes: --- - "Cited By (since 1996): 67" - "Export Date: 17 November 2011" - "CODEN: IOBPD" - "Source: Scopus"
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MSK Authors
  1. Zhixiong Lin
    1 Lin
  2. Carlo Greco
    11 Greco
  3. Nancy Y. Lee
    600 Lee
  4. Heiko Schoder
    313 Schoder
  5. Shangde Cai
    42 Cai
  6. Sadek Nehmeh
    67 Nehmeh
  7. John Laurence Humm
    357 Humm
  8. Pat B Zanzonico
    266 Zanzonico
  9. C Clifton Ling
    324 Ling
  10. Olivia D Squire
    32 Squire
  11. Kelvin Chan
    19 Chan