Assessment of hypoxic subvolumes in laryngeal cancer with F-18-fluoroazomycinarabinoside (F-18-FAZA)-PET/CT scanning and immunohistochemistry

Leonie Bruine de Bruin, Vikram R. Bollineni, Jan E. Wachters, Ed Schuuring, Bettien M. van Hemel, Jacqueline E van der Wal, Lorian Slagter-Menkema, Geertruida H. de Bock, Roel J. H. M. Steenbakkers, Johannes A. Langendijk, Jan Pruim, Bernard F. A. M. van der Laan, Gyorgy B. Halmos*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

10 Citations (Scopus)


Background and purpose: F-18-fluoroazomycinarabinoside (F-18-FAZA) is a promising hypoxia radiopharmaceutical agent with outstanding biokinetic parameters. We aimed to determine the accuracy of F-18-FAZA-PET/CT scan in detecting hypoxic regions within the tumor using immunohistochemical markers in a pilot study.

Patients and methods: Eleven patients with primary or recurrent laryngeal squamous cell carcinoma were indicated for total laryngectomy (TLE). Patients underwent F-18-FAZA-PET/CT scan before TLE. Hypoxic regions inside the laryngeal tumor were determined. After TLE, regions with high uptake on F-18-FAZA-PET scan were selected for immunohistochemical examination for exogenous (pimonidazole) and endogenous (HIFI alpha, CA-IX and GLUT-1) hypoxia markers. To assess the accuracy of F-18-FAZA-PET scanning, radiopharmacon accumulation was related with immunohistochemical expression of hypoxia markers.

Results: Inter- and intratumoral heterogeneity of tumor hypoxia was observed on F-18-FAZA-PET scan. Nine of the eleven tumors were hypoxic with F-18-FAZA-PET. Hypoxia could also be detected with pimonidazole, HIFI alpha, CA-IX and GLUT-1 expression in some tumors. No clear association was observed between F-18-FAZA uptake and hypoxia markers.

Conclusions: This pilot study could not prove the accuracy of F-18-FAZA-PET in determining hypoxic sub-volumes in laryngeal cancer. Further study is required to investigate the benefit of F-18-FAZA-PET imaging in radiotherapy planning. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

Original languageEnglish
Pages (from-to)106-112
Number of pages7
JournalRadiotherapy and Oncology
Issue number1
Publication statusPublished - Oct-2015


  • F-18-FAZA-PET
  • Hypoxia markers
  • Laryngeal cancer
  • Tumor hypoxia
  • CA-IX
  • HEAD
  • PET

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