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Correlation of p 16 status, hypoxic imaging using [18 F ]‐misonidazole positron emission tomography and outcome in patients with loco‐regionally advanced head and neck cancer
Author(s) -
Trinkaus Mateya E,
Hicks Rodney J,
Young Richard J,
Peters Lester J,
Solomon Ben,
Bressel Mathias,
Corry June,
Fisher Richard,
Binns David,
McArthur Grant A,
Rischin Danny
Publication year - 2014
Publication title -
journal of medical imaging and radiation oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.31
H-Index - 43
eISSN - 1754-9485
pISSN - 1754-9477
DOI - 10.1111/1754-9485.12155
Subject(s) - misonidazole , medicine , tirapazamine , head and neck cancer , head and neck squamous cell carcinoma , positron emission tomography , hypoxia (environmental) , tumor hypoxia , radiation therapy , hazard ratio , cisplatin , oncology , nuclear medicine , confidence interval , chemotherapy , biochemistry , chemistry , organic chemistry , cytotoxicity , oxygen , in vitro
We investigated the relationship between hypoxia, human papillomavirus (HPV) status and outcome in head and neck squamous cell carcinoma. Methods Patients with stage III and IV head and neck squamous cell carcinoma treated on phase I and II chemoradiation trials with 70‐ Gy radiation combined with tirapazamine/cisplatin or cisplatin/fluorouracil (5 FU ), hypoxic imaging using [18 F ]‐misonidazole positron emission tomography and known HPV status (by p 16 immunohistochemistry) were included in this sub‐study. Separate analyses were conducted to consider the impact of tirapazamine on HPV ‐negative tumours in the phase II trial. Results Both p 16‐positive oropharyngeal tumours and p 16‐negative head and neck squamous cell carcinoma tumours had a high prevalence of tumour hypoxia; 14/19 (74%) and 35/44 (80%), respectively. The distribution of hypoxia (primary, nodal) was similar. On phase II , trial patients with p 16‐negative hypoxic tumours had worse loco‐regional control with cisplatin and 5 FU compared with tirapazamine and cisplatin ( P < 0.001) and worse failure‐free survival (hazard ratio = 5.18; 95% confidence interval, 1.98–13.55; P = 0.001). Only 1 out of 14 p16‐positive patients on the phase II trial experienced loco‐regional failure. Conclusion Hypoxia, as assessed by [18 F ]‐misonidazole positron emission tomography, is frequently present in both p 16‐positive and negative head and neck cancer. Further research is required to determine whether hypoxic imaging can be used to predict benefit from hypoxia‐targeting therapies in patients with p 16‐negative tumours.