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Oncology-Clinical Diagnosis: Solid TumorsGI Cancers - Colorectal and Liver |
1 Department of Nuclear Medicine; 2 Department of General and Visceral Surgery; 3 Department of Pathology, University Hospital Freiburg, Freiburg, BW, Germany; 4 Philips Technology GmbH, Aachen, NRW, Germany
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Objectives: To investigate the distribution of FMISO in esophageal cancer. Beside other parameters, hypoxia might influence the results of neoadjuvant therapy. It has been shown that PET with 18F-fluoromisonidazole (FMISO) allows the visualization of hypoxia in a variety of tumors. PET-data about hypoxia in esophageal cancer are still missing.
Methods: 38 Patients with histologically proven esophageal carcinoma (18 squamous cell carcinomas (SCC), 20 adenocarcinomas (AC) underwent FMISO PET. All primary tumors had visual detectable FDG-accumulation in previous PET scans. Standard uptake values (SUV) of FMISO accumulation were calculated. Furthermore, hypoxic volume was derived from counting all pixels with tumor/blood ratio >1.3. Blood activity was determined in the left ventricle.
Results: Hypoxia was identified in 33 patients, of whom 30 showed a homogenous subvolume and 3 multifocal uptake. The average hypoxic volume of 3.9±4.3 ml represented a noticeable part of the mean tumor volume (27.2±33.8 ml). The FMISO uptake was significantly higher in AC (SUVmax=2.24±0.49 and SUVmean=1.93±0.43) than in SCC (SUVmax=1.89±0.36 and SUVmean=1.56±0.25; both t-test p<0.01) whereas the glucose metabolism did not differ significantly.
Conclusions: Most esophageal carcinomas contain hypoxic areas which can be detected non-invasively by FMISO PET. The difference in the tumor metabolism of esophageal AC and SCC supports concepts justifying differentiated therapeutic approaches for these two tumor entities.
Research Support: DFG grant BR 2293
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