FDG - A marker of tumour hypoxia? A comparison with [18F] fluoromisonidazole and pO2-polarography in metastatic head and neck cancer

Department of Nuclear Medicine, University Hospital Aachen, Aachen, Germany.
European Journal of Nuclear Medicine (Impact Factor: 5.38). 12/2006; 33(12):1426-31. DOI: 10.1007/s00259-006-0175-6
Source: PubMed

ABSTRACT Experimental data suggest that the accumulation of [(18)F]fluorodeoxyglucose (FDG) in malignant tumours is related to regional hypoxia. The aim of this study was to evaluate the clinical potential of FDG positron emission tomography (PET) to assess tumour hypoxia in comparison with [(18)F]fluoromisonidazole (FMISO) PET and pO(2)-polarography.
Twenty-four patients with head and neck malignancies underwent FDG PET, FMISO PET, and pO(2)-polarography within 1 week. Parameters of pO(2)-polarography were the relative frequency of pO(2) readings <or=2.5 mmHg, <or=5 mmHg and <or=10 mmHg, respectively, as well as the mean and median pO(2).
We observed a moderate correlation of the maximum standardised uptake value (SUV) of FDG with the tumour to blood ratio of FMISO at 2 h (R=0.53, p<0.05). However, SUV of FDG was similar in hypoxic and normoxic tumours as defined by pO(2)-polarography (6.9+/-3.2 vs 6.2+/-3.0, NS), and the FDG uptake was not correlated with the results of pO(2)-polarography. The retention of FMISO was significantly higher in hypoxic tumours than in normoxic tumours (tumour to muscle ratio at 2 h: 1.8+/-0.4 vs 1.4+/-0.1, p<0.05), and the FMISO tumour to muscle ratio showed a strong correlation with the frequency of pO(2) readings <or=5 mmHg (R=0.80, p<0.001).
These results support the hypothesis that tumour hypoxia has an effect on glucose metabolism. However, other factors affecting FDG uptake may be more predominant in chronic hypoxia, and thus FDG PET cannot reliably differentiate hypoxic from normoxic tumours.

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    • "The oncolytic appetite for glycolysis is thought to be caused by a number of genetic or possibly epigenetic changes that drive malignancy [13] [14]. Many studies have been carried out to correlate FDG uptake with various physiological parameters, such as hypoxia, proliferation, blood flow, histology, and differentiation , utilizing FDG-PET and immunohistochemical methods [15] [16] [17] [18] [19] [20]. However, although several studies have shown the relationship between the FDG uptake and hypoxia or proliferation , the underlying mechanism of FDG uptake in a tumor is still unclear. "
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    • "Additionally, 18 F-FDG has also been proposed as a surrogate marker of tumor hypoxia following the potential increased cell metabolism from oxidative phosphorylation to glycolysis when oxygen level drops [33]. This induce an increase in the uptake of glucose but despite this well-characterized connection, preclinical and clinical studies have reported conflicting results; but in general 18 F-FDG cannot be considered as a consistent surrogate marker of hypoxia in tumors [34] [35] [36] [37] [38] [39]. "
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