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Correlation between tumour biology status measured in triple-tracer 18F-fluorodeoxyglucose–18F-fluorothymidine– 18F-fluoromisonidazole-PET/CT study and human papillomavirus status in patients with head and neck cancer

Cegla, Paulinaa; Joanna, Kazmierskad,b; Sebastian, Gwozdza; Julian, Malickid,c; Michal, Smolena; Witold, Cholewinskid,a

Nuclear Medicine Communications: July 2019 - Volume 40 - Issue 7 - p 752–757
doi: 10.1097/MNM.0000000000001016

Objective Human papillomavirus (HPV) has been usually associated with gynaecological cancers; however, recent studies have shown that this virus plays an important role in head and neck cancer. The aim of this study was to correlate PET/CT parameters in HPV-positive (HPV+) and HPV-negative (HPV) patients using three tracers showing glucose metabolism, proliferation and hypoxia.

Patients and methods Thirty-six patients (10 females and 26 males) with newly diagnosed head and neck cancer were enroled to this retrospective study. All patients underwent a series of three PET/CT scans with fluorine-18-fluorodeoxyglucose (18F-FDG), fluorine-18-fluorothymidine (18F-FLT) and fluorine-18-fluoromisonidazole (18F-FMISO). Scans were performed on separate days, within a time-frame of 2 weeks. We compared several PET/CT parameters grading tumour biology including maximum standardized uptake value (SUV), total lesion glycolysis, totalSUV and heterogeneity between HPV+ and HPV patients. For statistical analysis, t-test and Mann–Whitney test were used and the materiality level of P values less than 0.05 were considered significant.

Results Patient with HPV showed higher SUV values than patients with HPV+ in 18F-FLT images (6.34±2.5 vs. 5.99±3.6) and 18F-FMISO images (1.66±0.33 vs. 1.62±1.28) and lower values in 18F-FDG images (9.99±3.85 vs. 10.28±2.44). However, analyzing total lesion glycolysis values in all tracers, HPV patients showed higher values than HPV+ patients [18F-FDG (92.21±102.9 vs. 70.83±74.27), 18F-FMISO (30.75±30.1 vs. 25.13±31.34) and 18F-FLT (138.71±132.9 vs. 109.61±92.7)].

Conclusion In our preliminary and limited study, we did not observe statistically significant differences in tumour metabolism, proliferation and hypoxia between the HPV+ and HPVpatients. However HPV patients tend to have higher proliferation status and more pronounced hypoxia with lower glucose metabolism.

Departments of aNuclear Medicine

b2nd Radiotherapy

cMedical Physics, Greater Poland Cancer Centre

dChair and Department of Electroradiology, Medical University, Poznan, Poland

Correspondence to Paulina Cegla, MSc, Department of Nuclear Medicine, Greater Poland Cancer Center, Garbary 15, 61-866 Poznan, Poland Tel: +48 61 885 9789; fax: +48 61 885 0785; e-mail:

Received October 28, 2018

Received in revised form March 2, 2019

Accepted March 18, 2019

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