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Head and Neck Tumor Hypoxia Imaging by 18F-Fluoroazomycin-arabinoside (18F-FAZA)-PET: A Review

Halmos, Gyorgy B. MD, PhD*; Bruine de Bruin, Leonie MD*†; Langendijk, Johannes A. MD, PhD; van der Laan, Bernard F. A. M. MD, PhD*; Pruim, Jan MD, PhD§∥; Steenbakkers, Roel J. H. M. MD, PhD

doi: 10.1097/RLU.0000000000000286
Review Article

Abstract: Tumor hypoxia is known to be associated with poor clinical outcome; therefore, patients with hypoxic tumors might benefit from more intensive treatment approaches. This is particularly true for patients with head and neck cancer. Pretreatment assessment of hypoxia in tumors would be desirable, not only to predict prognosis but also to select patients for more aggressive treatment.

As an alternative to the invasive polarographic needle electrode method, there is the possibility of using PET with radiopharmaceuticals visualizing hypoxia. Most hypoxia imaging studies on head and cancer have been performed using 18F-labeled fluoromisonidazole (18F-FMISO). A chemically related molecule, 18F-fluoroazomycin-arabinoside (18F-FAZA), seems to have superior kinetic properties and may therefore be the radiopharmaceutical of choice.

This minireview summarizes the published literature on animal and human 18F-FAZA PET studies. Furthermore, future perspectives on how individualized treatment could be applied in patients with hypoxic head and neck tumors are discussed, for instance, the use of hypoxia sensitizers or special intensity-modulated radiation therapy techniques achieving tumor subvolume dose escalation.

From the *Department of Otolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen; †Graduate School of Medical Sciences (Groningen University Institute for Drug Exploration), ‡Department of Radiation Oncology, §Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, the Netherlands; and ∥Department of Nuclear Medicine, Tygerberg Hospital, Stellenbosch University, Stellenbosch, South Africa.

Received for publication July 18, 2013; revision accepted September 17, 2013.

Conflicts of interest and sources of funding: none declared.

Reprints: Gyorgy B. Halmos, MD, PhD, Department of Otolaryngology, Head and neck Surgery, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700RB Groningen, the Netherlands. E-mail: g.b.halmos@umcg.nl.

© 2014 by Lippincott Williams & Wilkins