Textural features of hypoxia PET predict survival in head and neck cancer during chemoradiotherapy

A Sörensen; M Carles; H Bunea; L Majerus; C Stoykow; N H Nicolay; N E Wiedenmann; P Vaupel; P T Meyer; A L Grosu; M Mix

doi:10.1007/s00259-019-04609-9

Textural features of hypoxia PET predict survival in head and neck cancer during chemoradiotherapy

Eur J Nucl Med Mol Imaging. 2020 May;47(5):1056-1064. doi: 10.1007/s00259-019-04609-9. Epub 2019 Nov 26.

Authors

A Sörensen¹, M Carles², H Bunea², L Majerus², C Stoykow³, N H Nicolay^{2

4}, N E Wiedenmann², P Vaupel^{2

4}, P T Meyer^{3

4}, A L Grosu^{2

4}, M Mix^{3

5}

Affiliations

¹ Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany. [email protected].
² Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany.
³ Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
⁴ German Cancer Consortium (Deutsches Konsortium für Translationale Krebsforschung, DKTK) Partner Site Freiburg, 79106, Freiburg, Germany.
⁵ Department of Medical Imaging and Clinical Oncology, Nuclear Medicine Division, Faculty of Medicine and Health Science, Stellenbosch University, Tygerberg, Cape Town, 7505, South Africa.

PMID: 31773233
DOI: 10.1007/s00259-019-04609-9

Abstract

Purpose: The aim of this study was to investigate whether textural features of tumour hypoxia, assessed with serial [¹⁸F]fluoromisonidazole (FMISO)-PET, were able to predict clinical outcome in patients with head and neck squamous cell carcinoma (HNSCC, T1-4, N+, M0) during chemoradiotherapy (CRT).

Methods: In a preliminary evaluation of a prospective trial, tumour hypoxia was evaluated in 29 patients via serial FMISO-PET before and during CRT. All patients received an initial [¹⁸F]fluorodeoxyglucose (FDG)-PET before CRT, and tumour regions were defined on this FDG-PET. The first-order metrics tumour-to-background ratio (TBR_mean, TBR_max, TBR_peak), coefficient of variation, total lesion uptake and integral non-uniformity were calculated for all scans. Further, 3 second-order (textural) features from two grey-level matrices were calculated, as well as differential non-uniformity (u_diff). Prognostic value was examined by median split for group separation (GS) in Kaplan-Meier estimates and correlated with overall survival (OS), quantified via log-rank tests (p ≤ 0.05) and group-relative hazard ratios (HR).

Results: Within a median follow-up of 29.6 months (95% CI: 16.8-48.0 months), no first-order metrics predicted OS with a significant GS (all p > 0.05) on any FMISO-PET scan. Only u_diff before and in week 2 during CRT (p = 0.03, HR = 10.8 and p = 0.05, HR = 5.2) and non-uniformity from grey-level run length matrix in week 2 separated prognostic groups (p = 0.05, HR = 5.3); lower values were correlated with better OS. Further, the decrease in u_diff from before CRT to week 2 was correlated with better OS (p = 0.04, HR = 9.4). FDG-PET before CRT did not predict outcome in any measure.

Conclusions: Textural features on FMISO-PET scans before CRT, in week 2 and, to a limited degree, the change of features during CRT, were able to identify head and neck squamous cell carcinoma patients with better OS, suggesting that a higher homogeneity of the degree of hypoxia in tumours could correlate with a better outcome after CRT.

Keywords: CRT; FDG; FMISO; HNSCC; Hypoxia; Radiomics.

Publication types

Clinical Trial

MeSH terms

Chemoradiotherapy
Fluorodeoxyglucose F18*
Head and Neck Neoplasms* / diagnostic imaging
Head and Neck Neoplasms* / therapy
Humans
Hypoxia
Positron-Emission Tomography
Prospective Studies

Substances

Fluorodeoxyglucose F18