Evaluation of tumor hypoxia prior to radiotherapy in intermediate-risk prostate cancer using 18F-fluoromisonidazole PET/CT: a pilot study
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Stéphane Supiot1,2,*, Caroline Rousseau1,2,*, Mélanie Dore1,2, Catherine Cheze-Le-Rest3, Christine Kandel-Aznar4, Vincent Potiron1,2, Stéphane Guerif3, François Paris1,2, Ludovic Ferrer1,2, Loïc Campion1,2, Philippe Meingan1, Gregory Delpon1,2, Mathieu Hatt5 and Dimitris Visvikis5
1Institut de Cancérologie de l'Ouest, Bld Jacques Monod, 44805 Nantes-Saint Herblain, France
2Centre de Recherche en Cancérologie Immunologie Nantes/Angers (CRCNA, UMR 1232 INSERM), Institut de Recherche en Santé de l'Université de Nantes, 44007 Nantes CEDEX 1, France
3Centre Hospitalier Universitaire, 86021 Poitiers, France
4Centre Hospitalier Universitaire, 44000 Nantes, France
5Laboratoire de Traitement de l'Information Médicale (LaTIM), INSERM, UMR 1101, IBSAM, UBO, UBL, IBRBS, Faculté de Médecine, 29238 Brest, France
*These authors contributed equally to this work
Stéphane Supiot, email: [email protected]
Keywords: hypoxia; prostate cancer; misonidazole; FAZA; HIF
Received: August 29, 2017 Accepted: December 11, 2017 Published: January 13, 2018
Purpose: Hypoxia is a major factor in prostate cancer aggressiveness and radioresistance. Predicting which patients might be bad candidates for radiotherapy may help better personalize treatment decisions in intermediate-risk prostate cancer patients. We assessed spatial distribution of 18F-Misonidazole (FMISO) PET/CT uptake in the prostate prior to radiotherapy treatment.
Materials and Methods: Intermediate-risk prostate cancer patients about to receive high-dose (>74 Gy) radiotherapy to the prostate without hormonal treatment were prospectively recruited between 9/2012 and 10/2014. Prior to radiotherapy, all patients underwent a FMISO PET/CT as well as a MRI and 18F-choline-PET. 18F-choline and FMISO-positive volumes were semi-automatically determined using the fuzzy locally adaptive Bayesian (FLAB) method. In FMISO-positive patients, a dynamic analysis of early tumor uptake was performed. Group differences were assessed using the Wilcoxon signed rank test. Parameters were correlated using Spearman rank correlation.
Results: Of 27 patients (median age 76) recruited to the study, 7 and 9 patients were considered positive at 2.5h and 3.5h FMISO PET/CT respectively. Median SUVmax and SUVmax tumor to muscle (T/M) ratio were respectively 3.4 and 3.6 at 2.5h, and 3.2 and 4.4 at 3.5h. The median FMISO-positive volume was 1.1 ml.
Conclusions: This is the first study regarding hypoxia imaging using FMISO in prostate cancer showing that a small FMISO-positive volume was detected in one third of intermediate-risk prostate cancer patients.
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