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Hypoxia imaging with [18F]HX4 PET in squamous cell head and neck cancer: a pilot study for integration into treatment planning

Betts, Helen M.; O'Connor, R. Angus; Christian, Judith A.; Vinayakamoorthy, Vidhiya; Foweraker, Karen; Pascoe, Abigail C.; Perkins, Alan C.


Helen M. Betts

R. Angus O'Connor

Judith A. Christian

Vidhiya Vinayakamoorthy

Karen Foweraker

Abigail C. Pascoe

Alan C. Perkins


Background: Radical chemoradiotherapy is the primary treatment for head and neck cancers in many hospitals. Tumour hypoxia causes radiotherapy resistance, and is an indicator of poor prognosis for patients. Identifying hypoxia to select patients for intensified or hypoxia-modified treatment regimens is therefore of high clinical importance.
Patients and Methods: We evaluated hypoxia in a group of patients with newly diagnosed squamous cell head and neck cancer using the hypoxia-selective radiotracer [18F]HX4. Patients underwent a single [18F]HX4 PET/CT scan prior to beginning chemoradiotherapy.
Results: Three out of eight patients recruited were scanned with [18F]HX4. Two out of three had pre-treatment [18F]FDGPET/CT scans available for review. [18F]HX4 tumour uptake varied between patients, with tumour to mediastinal ratios ranging from1 to3.5.
Conclusions: The spectrum of [18F]HX4 uptake in this small series of patients exemplifies the difference in oxygenation profiles between histologically similar tumours. Performing an additional PET scan with [18F]HX4 prior to chemoradiotherapy treatment was logistically challenging in a routine setting, and therefore validation of its clinical impact should be the focus of future studies.


Betts, H. M., O'Connor, R. A., Christian, J. A., Vinayakamoorthy, V., Foweraker, K., Pascoe, A. C., & Perkins, A. C. (2019). Hypoxia imaging with [18F]HX4 PET in squamous cell head and neck cancer: a pilot study for integration into treatment planning. Nuclear Medicine Communications, 40(1), 73-78.

Journal Article Type Article
Acceptance Date Oct 5, 2018
Online Publication Date Oct 26, 2018
Publication Date Jan 1, 2019
Deposit Date Oct 10, 2018
Publicly Available Date Oct 30, 2018
Journal Nuclear Medicine Communications
Print ISSN 0143-3636
Electronic ISSN 1473-5628
Publisher Lippincott, Williams & Wilkins
Peer Reviewed Peer Reviewed
Volume 40
Issue 1
Pages 73-78
Public URL
Publisher URL
Additional Information Funded by Nottingham Hospitals Charity


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