Imaging of hypoxia with <sup>18</sup><scp>F</scp>‐<scp>FAZA PET</scp> in patients with locally advanced non‐small cell lung cancer treated with definitive chemoradiotherapy

Trinkaus, Martina; Blum, Rob; Rischin, Danny; Callahan, Jason; Bressel, Mathias; Segard, Tatiana; Roselt, Peter; Eu, Peter; Binns, David; MacManus, Michael; Ball, David; Hicks, Rodney J.

doi:10.1111/1754-9485.12086

Cited by 59 publications

(32 citation statements)

References 20 publications

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“…Among these tracers, [ . This allows for a shorter time interval between injection and imaging [58] . In addition, [ 18 F]FAZA has a high parent fraction during imaging, accounting for a parent fraction of 90% at 70 min after injection [59] .…”

Section: Characteristics Of a Hypoxia Pet Tracermentioning

confidence: 99%

“…Reischl et al [165] , Piert et al [166] , Picchio et al [167] , Maier et al [168] , Tran et al [169] Barthel et al [187] Busk et al [170] , Mortensen et al [171] , Piert et al [166] , Tran et al [169] Barthel et al [187] Busk et al [170] , Busk et al [172] , Busk et al [173] , Busk et al [174] , Busk et al [175] , Graves et al [176] , Maier et al [168] , Solomon et al [177] NA Belloli et al [178] , Picchio et al [167] , Troost et al [179] , Valtorta et al [143] NA Sorger et al [57] , Piert et al [166] , Reischl et al [165] Rasey et al [188] Postema et al [180] , Bollineni et al [181] , Trinkaus et al [58] , Verwer et al [59] NA Grosu et al [182] , Souvatzoglou et al [183] , Schuetz et al [184] , Shi et al [106] , Mortensen et al [185] , Havelund et al [186] NA…”

Section: F]ef5mentioning

confidence: 99%

“…In addition, a number of studies have evaluated the changes in hypoxia tracer uptake during therapy. While hypoxic cells are considered to be more resistant to radiation therapy, most studies in lung cancer reported a decrease in hypoxia tracer uptake after radiation therapy [58,82,87] .…”

Section: Determination Of Clinically Relevant Hypoxiamentioning

confidence: 99%

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Positron emission tomography to assess hypoxia and perfusion in lung cancer

Verwer

Boellaard

Veldt

2014

WJCO

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Core tip:This review provides an overview of the current applications of positron emission tomography for hypoxia and perfusion imaging in lung cancer. Available PET tracers are discussed and the benefits of combined hypoxia and perfusion PET imaging are clarified. Hypoxia imaging could aid in selecting patients for hypoxia-specific treatment strategies. To achieve this, consensus about the optimal imaging protocol and quantification method is essential. Large clinical trials are needed to confirm the value of hypoxia imaging for improving patient care.Verwer EE, Boellaard R, van der Veldt AAM. Positron emission tomography to assess hypoxia and perfusion in lung cancer.

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Section: Characteristics Of a Hypoxia Pet Tracermentioning

confidence: 99%

Section: F]ef5mentioning

confidence: 99%

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Positron emission tomography to assess hypoxia and perfusion in lung cancer

Verwer

Boellaard

Veldt

2014

WJCO

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“…Under hypoxic conditions, however, the tracer is retained within the cell, increasing the PET signal in areas containing hypoxic cells (1). In comparison with other PET hypoxia tracers, 18 F-FAZA is more sensitive for separating hypoxic tissue from nonhypoxic tissue due to its rapid renal clearance, which results in lower background activity levels (6,7).…”

mentioning

confidence: 99%

“…Most methods for analyzing the uptake of PET hypoxia tracers do not account for potential perfusion effects (3,6,10). In principle, low perfused areas should show higher uptake of 18 F-FAZA, whereas high perfused areas may have a sufficient oxygen supply and show low uptake of 18 F-FAZA.…”

mentioning

confidence: 99%

Multiparametric Analysis of the Relationship Between Tumor Hypoxia and Perfusion with ¹⁸F-Fluoroazomycin Arabinoside and ¹⁵O-H₂O PET

et al. 2015

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18 F-fluoroazomycin arabinoside ( 18 F-FAZA) is a PET tracer of tumor hypoxia. However, as hypoxia often is associated with decreased perfusion, the delivery of 18 F-FAZA may be compromised, potentially disturbing the association between tissue hypoxia and 18 F-FAZA uptake. The aim of this study was to gain insight into the relationship between tumor perfusion and 18 F-FAZA uptake. Methods: Ten patients diagnosed with advanced non-small cell lung cancer underwent subsequent dynamic 15 O-H 2 O and 18 F-FAZA PET scans with arterial sampling. Parametric images of both 15 O-H 2 O-derived perfusion (tumor blood flow [TBF]) and volume of distribution (V T ) of 18 F-FAZA were generated. Next, multiparametric classification was performed using lesional and global thresholds. Voxels were classified as low or high TBF and 18 F-FAZA V T , respectively. Finally, by combining these initial classifications, voxels were allocated to 4 categories: lowTBF-lowV T , lowTBF-highV T , highTBF-lowV T , and highTBF-highV T . Results: A total of 13 malignant lesions were identified in the 10 patients. The TBF and 18 F-FAZA V T values (average ± SD) across all lesions were 0.45 ± 0.20 mLÁcm −3 Ámin −1 and 0.94 ± 0.31 mLÁcm −3 , respectively. The averages of all lesional median values for TBF and 18 F-FAZA V T were 0.37 ± 0.15 mLÁcm −3 Ámin −1 and 0.85 ± 0.18 mLÁcm −3 , respectively. Multiparametric analysis showed that classified voxels were clustered rather than randomly distributed. Several intralesion areas were identified where 18 F-FAZA V T was inversely related to TBF. On the other hand, there were also distinct areas where TBF as well as 18 F-FAZA V T were decreased or increased. Conclusion: The present data indicate that spatial variation of 18 F-FAZA uptake is not necessarily inversely related to TBF. This suggests that decreased TBF may result in flow-limited delivery of 18 F-FAZA. Areas with both high 18 F-FAZA uptake and high TBF values suggest that high 18 F-FAZA uptake, possibly suggesting hypoxia, may occur despite high TBF values. In conclusion, multiparametric evaluation of the spatial distributions of both TBF and 18 F-FAZA uptake may be helpful for understanding the 18 F-FAZA signal.

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Optimising hypoxia PET imaging and its applications in guiding targeted radiation therapy for non‐small cell lung cancer: a scoping review

Marks,

Leech

2024

J of Medical Radiation Sci

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IntroductionNon‐small cell lung cancer (NSCLC) is the leading cause of cancer‐related death. Definitive treatment includes chemotherapy and radiation therapy. Tumour hypoxia impacts the efficacy of these treatment modalities. Novel positron‐emission tomography (PET) imaging has been developed to non‐invasively quantify hypoxic tumour subregions, and to guide personalised treatment strategies. This review evaluates the reliability of hypoxia imaging in NSCLC in relation to various tracers, its correlations to treatment‐related outcomes, and to assess if this imaging modality can be meaningfully applied into radiation therapy workflows.MethodsA literature search was conducted on the Medline (Ovid) and Embase databases. Searches included terms related to ‘hypoxia’, ‘positron‐emission tomography’, ‘magnetic resonance imaging’ and ‘lung cancer’. Results were filtered to exclude studies prior to 2011, and animal studies were excluded. Only studies referring to a confirmed pathology of NSCLC were included, while disease staging was not a limiting factor. Full‐text English language and translated literature examined included clinical trials, clinical cohort studies and feasibility studies.ResultsQuantification of hypoxic volumes in a pre‐treatment setting is of prognostic value, and indicative of treatment response. Dosimetric comparisons have highlighted potential to significantly dose escalate to hypoxic volumes without risk of additional toxicity. However, clinical data to support these strategies are lacking.ConclusionHeterogenous study design and non‐standardised imaging parameters have led to a lack of clarity regarding the application of hypoxia PET imaging in NSCLC. PET imaging using nitroimidazole tracers is the most investigated method of non‐invasively measuring tumour hypoxia and has potential to guide hypoxia‐targeted radiation therapy. Further clinical research is required to elucidate the benefits versus risks of dose‐escalation strategies.

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Imaging of hypoxia with ¹⁸F‐FAZA PET in patients with locally advanced non‐small cell lung cancer treated with definitive chemoradiotherapy

Cited by 59 publications

References 20 publications

Positron emission tomography to assess hypoxia and perfusion in lung cancer

Positron emission tomography to assess hypoxia and perfusion in lung cancer

Multiparametric Analysis of the Relationship Between Tumor Hypoxia and Perfusion with ¹⁸F-Fluoroazomycin Arabinoside and ¹⁵O-H₂O PET

Optimising hypoxia PET imaging and its applications in guiding targeted radiation therapy for non‐small cell lung cancer: a scoping review

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Imaging of hypoxia with 18F‐FAZA PET in patients with locally advanced non‐small cell lung cancer treated with definitive chemoradiotherapy

Cited by 59 publications

References 20 publications

Positron emission tomography to assess hypoxia and perfusion in lung cancer

Positron emission tomography to assess hypoxia and perfusion in lung cancer

Multiparametric Analysis of the Relationship Between Tumor Hypoxia and Perfusion with 18F-Fluoroazomycin Arabinoside and 15O-H2O PET

Optimising hypoxia PET imaging and its applications in guiding targeted radiation therapy for non‐small cell lung cancer: a scoping review

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Imaging of hypoxia with ¹⁸F‐FAZA PET in patients with locally advanced non‐small cell lung cancer treated with definitive chemoradiotherapy

Multiparametric Analysis of the Relationship Between Tumor Hypoxia and Perfusion with ¹⁸F-Fluoroazomycin Arabinoside and ¹⁵O-H₂O PET