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First published online June 12, 2009, 10.2967/jnumed.109.062638
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Dose Painting in Radiotherapy for Head and Neck Squamous Cell Carcinoma: Value of Repeated Functional Imaging with 18F-FDG PET, 18F-Fluoromisonidazole PET, Diffusion-Weighted MRI, and Dynamic Contrast-Enhanced MRI

Piet Dirix1, Vincent Vandecaveye2, Frederik De Keyzer2, Sigrid Stroobants3, Robert Hermans2 and Sandra Nuyts1

1 Department of Radiation Oncology, Leuvens Kankerinstituut, University Hospitals Leuven, Leuven, Belgium; 2 Department of Radiology, Leuvens Kankerinstituut, University Hospitals Leuven, Leuven, Belgium; and 3 Department of Nuclear Medicine, Leuvens Kankerinstituut, University Hospitals Leuven, Leuven, Belgium


Figure 1
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  		FIGURE 1.  Treatment and imaging protocol.

 

Figure 2
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  		FIGURE 2.  Actuarial disease-free survival according to T/Bmax before radiotherapy (n = 12). High T/Bmax is defined as a value greater than or equal to median of 1.45.

 

Figure 3
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  		FIGURE 3.  Actuarial disease-free survival according to T/Bmax during radiotherapy (n = 15). High T/Bmax is defined as a value greater than or equal to median of 1.17.

 

Figure 4
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  		FIGURE 4.  (A and B) Pretreatment 18F-FDG PET showed metastatic adenopathy at level 2 (arrow) (A), which remained hypoxic on 18F-fluoromisonidazole PET scan during RT treatment (week 4) (B). (C and D) This lymph node still had restricted apparent diffusion coefficient on DW MRI at 3 wk after end of radiotherapy (C) and remained suspect on 18F-FDG PET at 8 wk after treatment (D). (E) Residual disease was confirmed in this node (patient 8).

 




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