Hypoxia and Glucose Metabolism in Malignant Tumors

Evaluation by [ 18F]Fluoromisonidazole and [18F]]Fluorodeoxyglucose Positron Emission Tomography Imaging

Joseph G. Rajendran, David A. Mankoff, Finbarr O'Sullivan, Lanell M. Peterson, David Schwartz, Ernest U. Conrad, Alexander M. Spence, Mark Muzi, D. Greg Farwell, Kenneth A. Krohn

Research output: Contribution to journalArticle

304 Citations (Scopus)

Abstract

Purpose: The aim of this study is to compare glucose metabolism and hypoxia in four different tumor types using positron emission tomography (PET). 18F-labeled fluorodeoxyglucose (FDG) evaluates energy metabolism, whereas the uptake of 18F-labeled fluoromisonidazole (FMISO) is proportional to tissue hypoxia. Although acute hypoxia results in accelerated glycolysis, cellular metabolism is slowed in chronic hypoxia, prompting us to look for discordance between FMISO and FDG uptake. Experimental Design: Forty-nine patients (26 with head and neck cancer, 11 with soft tissue sarcoma, 7 with breast cancer, and 5 with glioblastoma multiforme) who had both FMISO and FDG PET scans as part of research protocols through February 2003 were included in this study. The maximum standardized uptake value was used to depict FDG uptake, and hypoxic volume and maximum tissue: blood ratio were used to quantify hypoxia. Pixel-by-pixel correlation of radiotracer uptake was performed on coregistered images for each corresponding tumor plane. Results: Hypoxia was detected in all four patient groups. The mean correlation coefficients between FMISO and FDG uptake were 0.62 for head and neck cancer, 0.47 for breast cancer, 0.38 for glioblastoma multiforme, and 0.32 for soft tissue sarcoma. The correlation between the overall tumor maximum standardized uptake value for FDG and hypoxic volume was small (Spearman r = 0.24), with highly significant differences among the different tumor types (P < 0.005). Conclusions: Hypoxia is a general factor affecting glucose metabolism; however, some hypoxic tumors can have modest glucose metabolism, whereas some highly metabolic tumors are not hypoxic, showing discordance in tracer uptake that can be tumor type specific.

Original languageEnglish (US)
Pages (from-to)2245-2252
Number of pages8
JournalClinical Cancer Research
Volume10
Issue number7
DOIs
StatePublished - Apr 1 2004

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Fluorodeoxyglucose F18
Positron-Emission Tomography
Glucose
Neoplasms
Glioblastoma
Head and Neck Neoplasms
Breast Neoplasms
Sarcoma
Glycolysis
Hypoxia
fluoromisonidazole
Energy Metabolism
Research Design
Research

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Hypoxia and Glucose Metabolism in Malignant Tumors : Evaluation by [ 18F]Fluoromisonidazole and [18F]]Fluorodeoxyglucose Positron Emission Tomography Imaging. / Rajendran, Joseph G.; Mankoff, David A.; O'Sullivan, Finbarr; Peterson, Lanell M.; Schwartz, David; Conrad, Ernest U.; Spence, Alexander M.; Muzi, Mark; Farwell, D. Greg; Krohn, Kenneth A.

In: Clinical Cancer Research, Vol. 10, No. 7, 01.04.2004, p. 2245-2252.

Research output: Contribution to journalArticle

Rajendran, Joseph G. ; Mankoff, David A. ; O'Sullivan, Finbarr ; Peterson, Lanell M. ; Schwartz, David ; Conrad, Ernest U. ; Spence, Alexander M. ; Muzi, Mark ; Farwell, D. Greg ; Krohn, Kenneth A. / Hypoxia and Glucose Metabolism in Malignant Tumors : Evaluation by [ 18F]Fluoromisonidazole and [18F]]Fluorodeoxyglucose Positron Emission Tomography Imaging. In: Clinical Cancer Research. 2004 ; Vol. 10, No. 7. pp. 2245-2252.
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abstract = "Purpose: The aim of this study is to compare glucose metabolism and hypoxia in four different tumor types using positron emission tomography (PET). 18F-labeled fluorodeoxyglucose (FDG) evaluates energy metabolism, whereas the uptake of 18F-labeled fluoromisonidazole (FMISO) is proportional to tissue hypoxia. Although acute hypoxia results in accelerated glycolysis, cellular metabolism is slowed in chronic hypoxia, prompting us to look for discordance between FMISO and FDG uptake. Experimental Design: Forty-nine patients (26 with head and neck cancer, 11 with soft tissue sarcoma, 7 with breast cancer, and 5 with glioblastoma multiforme) who had both FMISO and FDG PET scans as part of research protocols through February 2003 were included in this study. The maximum standardized uptake value was used to depict FDG uptake, and hypoxic volume and maximum tissue: blood ratio were used to quantify hypoxia. Pixel-by-pixel correlation of radiotracer uptake was performed on coregistered images for each corresponding tumor plane. Results: Hypoxia was detected in all four patient groups. The mean correlation coefficients between FMISO and FDG uptake were 0.62 for head and neck cancer, 0.47 for breast cancer, 0.38 for glioblastoma multiforme, and 0.32 for soft tissue sarcoma. The correlation between the overall tumor maximum standardized uptake value for FDG and hypoxic volume was small (Spearman r = 0.24), with highly significant differences among the different tumor types (P < 0.005). Conclusions: Hypoxia is a general factor affecting glucose metabolism; however, some hypoxic tumors can have modest glucose metabolism, whereas some highly metabolic tumors are not hypoxic, showing discordance in tracer uptake that can be tumor type specific.",
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T1 - Hypoxia and Glucose Metabolism in Malignant Tumors

T2 - Evaluation by [ 18F]Fluoromisonidazole and [18F]]Fluorodeoxyglucose Positron Emission Tomography Imaging

AU - Rajendran, Joseph G.

AU - Mankoff, David A.

AU - O'Sullivan, Finbarr

AU - Peterson, Lanell M.

AU - Schwartz, David

AU - Conrad, Ernest U.

AU - Spence, Alexander M.

AU - Muzi, Mark

AU - Farwell, D. Greg

AU - Krohn, Kenneth A.

PY - 2004/4/1

Y1 - 2004/4/1

N2 - Purpose: The aim of this study is to compare glucose metabolism and hypoxia in four different tumor types using positron emission tomography (PET). 18F-labeled fluorodeoxyglucose (FDG) evaluates energy metabolism, whereas the uptake of 18F-labeled fluoromisonidazole (FMISO) is proportional to tissue hypoxia. Although acute hypoxia results in accelerated glycolysis, cellular metabolism is slowed in chronic hypoxia, prompting us to look for discordance between FMISO and FDG uptake. Experimental Design: Forty-nine patients (26 with head and neck cancer, 11 with soft tissue sarcoma, 7 with breast cancer, and 5 with glioblastoma multiforme) who had both FMISO and FDG PET scans as part of research protocols through February 2003 were included in this study. The maximum standardized uptake value was used to depict FDG uptake, and hypoxic volume and maximum tissue: blood ratio were used to quantify hypoxia. Pixel-by-pixel correlation of radiotracer uptake was performed on coregistered images for each corresponding tumor plane. Results: Hypoxia was detected in all four patient groups. The mean correlation coefficients between FMISO and FDG uptake were 0.62 for head and neck cancer, 0.47 for breast cancer, 0.38 for glioblastoma multiforme, and 0.32 for soft tissue sarcoma. The correlation between the overall tumor maximum standardized uptake value for FDG and hypoxic volume was small (Spearman r = 0.24), with highly significant differences among the different tumor types (P < 0.005). Conclusions: Hypoxia is a general factor affecting glucose metabolism; however, some hypoxic tumors can have modest glucose metabolism, whereas some highly metabolic tumors are not hypoxic, showing discordance in tracer uptake that can be tumor type specific.

AB - Purpose: The aim of this study is to compare glucose metabolism and hypoxia in four different tumor types using positron emission tomography (PET). 18F-labeled fluorodeoxyglucose (FDG) evaluates energy metabolism, whereas the uptake of 18F-labeled fluoromisonidazole (FMISO) is proportional to tissue hypoxia. Although acute hypoxia results in accelerated glycolysis, cellular metabolism is slowed in chronic hypoxia, prompting us to look for discordance between FMISO and FDG uptake. Experimental Design: Forty-nine patients (26 with head and neck cancer, 11 with soft tissue sarcoma, 7 with breast cancer, and 5 with glioblastoma multiforme) who had both FMISO and FDG PET scans as part of research protocols through February 2003 were included in this study. The maximum standardized uptake value was used to depict FDG uptake, and hypoxic volume and maximum tissue: blood ratio were used to quantify hypoxia. Pixel-by-pixel correlation of radiotracer uptake was performed on coregistered images for each corresponding tumor plane. Results: Hypoxia was detected in all four patient groups. The mean correlation coefficients between FMISO and FDG uptake were 0.62 for head and neck cancer, 0.47 for breast cancer, 0.38 for glioblastoma multiforme, and 0.32 for soft tissue sarcoma. The correlation between the overall tumor maximum standardized uptake value for FDG and hypoxic volume was small (Spearman r = 0.24), with highly significant differences among the different tumor types (P < 0.005). Conclusions: Hypoxia is a general factor affecting glucose metabolism; however, some hypoxic tumors can have modest glucose metabolism, whereas some highly metabolic tumors are not hypoxic, showing discordance in tracer uptake that can be tumor type specific.

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JO - Clinical Cancer Research

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