Referee report. For: PET measured hypoxia and MRI parameters in re-irradiated head and neck squamous cell carcinomas: findings of a prospective pilot study [version 1; peer review: 1 approved]

Jacqueline Kelly
Tumor hypoxia measured by dedicated tracers like [ 18 F]fluoromisonidazole (FMISO) is a well-established prognostic factor in head and neck squamous cell carcinomas (HNSCC) treated with definitive chemoradiation (CRT). However, prevalence and characteristics of positron emission tomography (PET) measured hypoxia in patients with relapse after previous irradiation is missing. Here we report imaging findings of a prospective pilot study in HNSCC patients treated with re-irradiation. Methods: In 8
more » ... tion. Methods: In 8 patients with recurrent HNSCC, diagnosed at a median of 18 months after initial radiotherapy/CRT, [ 18 F]fluorodeoxyglucose (FDG)-PET/CT (n=8) and FMISO-PET/MRI (n=7) or FMISO-PET/CT (n=1) were performed. Static FMISO-PET was performed after 180 min. MRI sequences in PET/MRI included diffusion-weighted imaging with apparent diffusion coefficient (ADC) values and contrast enhanced T1w imaging (StarVIBE). Lesions (primary tumor recurrence, 4; cervical lymph node, 1; both, 3) were delineated on FDG-PET and FMISO-PET data using a background-adapted threshold-based method. SUV max and SUV mean in FDG-and FMISO-PET were derived, as well as maximum tumor-to-muscle ratio (TMR max ) and hypoxic volume with 1.6-fold muscle SUV mean (HV 1.6 ) in FMISO-PET. Intensity of lesional contrast enhancement was rated relative to contralateral normal tissue. Average ADC values were derived from a 2D region of interest Open Peer Review Reviewer Status in the tumor. Results: In FMISO-PET, median TMR max was 1.7 (range: 1.1-1.8). Median HV 1.6 was 0.05 ml (range: 0-7.3 ml). Only in 2/8 patients, HV 1.6 was ≥1.0 ml. In FDG-PET, median SUV max was 9.3 (range: 5.0-20.1). On contrast enhanced imaging four lesions showed decreased and four lesions increased contrast enhancement compared to non-pathologic reference tissue. Median average ADC was 1,060 ×10 6 mm 2 /s (range: 840-1,400 ×10 6 mm 2 /s). Conclusions: This pilot study implies that hypoxia detectable by FMISO-PET may not be as prevalent as expected among loco-regional recurrent HNSCC. ADC values were only mildly reduced, and contrast enhancement was variable. The results require confirmation in larger sample sizes. PubMed Abstract | Publisher Full Text 8. Horsman MR, Mortensen LS, Petersen JB, et al.: Imaging hypoxia to improve radiotherapy outcome. Nat Rev Clin Oncol. 2012; 9(12): 674-687. PubMed Abstract | Publisher Full Text 9. Mortensen LS, Johansen J, Kallehauge J, et al.: FAZA PET/CT hypoxia imaging in patients with squamous cell carcinoma of the head and neck treated with radiotherapy: results from the DAHANCA 24 trial. Radiother Oncol. 2012; 105(1): 14-20. PubMed Abstract | Publisher Full Text 10. Welz S, Mönnich D, Pfannenberg C, et al.: Prognostic value of dynamic hypoxia PET in head and neck cancer: Results from a planned interim analysis of a randomized phase II hypoxia-image guided dose escalation trial. Radiother Oncol. 2017; 124(3): 526-532. PubMed Abstract | Publisher Full Text 11. Zips D, Zö phel K, Abolmaali N, et al.: Exploratory prospective trial of hypoxiaspecific PET imaging during radiochemotherapy in patients with locally advanced head-and-neck cancer. Radiother Oncol. 2012; 105(1): 21-28. PubMed Abstract | Publisher Full Text 12. Löck S, Perrin R, Seidlitz A, et al.: Residual tumour hypoxia in head-and-neck cancer patients undergoing primary radiochemotherapy, final results of a prospective trial on repeat FMISO-PET imaging. Radiother Oncol. 2017; 124(3): 533-540. PubMed Abstract | Publisher Full Text
doi:10.5256/f1000research.30169.r75138 fatcat:pfbqtwm5qzh47f6sur3cchrpni