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• W48651747 abstract "Aim: Fifty percent of patients with squamous cell carcinoma of the Head and Neckdevelop loco-regional recurrence after treatment. Factors leading to this failureare most likely altered intra-tumoural glucose metabolism and increased hypoxia.Tissue glucose utilisation and the degree of hypoxia can be visualised by CTPETimaging with 18FDG and hypoxic radio-nuclides.This thesis has investigated 18FDG CT-PET guided target volume delineationmethods and attempted to validate 64Cu-ATSM as a hypoxic radio-nuclide inpatients with squamous cell carcinoma of the Head and Neck.Materials and Methods: Eight patients with locally advanced disease underwent 18FDG CT-PET imagingbefore and during curative radiotherapy or chemo-radiotherapy. Fixed (SUV cutoff and percentage threshold of the SUVmax) and adaptive thresholds wereinvestigated. The functional volumes automatically delineated by these methodsand SUVmax were compared at each point, and between thresholds.Four patients with locally advanced disease, two to seven days prior to surgery,underwent 3D dynamic CT-PET imaging immediately after injection of 64Cu-ATSM. Two patients were also imaged 18 hours after injection, and twounderwent a dynamic contrast-enhanced CT to evaluate intra-tumoural perfusion.All patients received pimonidazole before surgery. The pimonidazole, GLUT1,CAIX, and HIF1a immuno-histochemical hypoxic fractions were defined.Staining was correlated with the retention pattern of 64Cu-ATSM at 3 timepoints. Hypoxic target volumes were delineated according to tumour to muscle,blood and background ratios. Results: 18FDG primary and lymph node target volumes significantly reduced withradiation dose by the SUV cut off method and correlated with the reduction inthe SUVmax within the volume. Volume reduction was also found betweenthresholds by the same delineation method. The volumes delineated by the othermethods were not significantly reduced (except the lymph node functionalvolume when defined by the adaptive threshold).64Cu-ATSM correlated with hypoxic immuno-histochemical staining but not withblood flow. Tumour ratios increased with time after injection, which influencedthe delineated hypoxic target volume.Conclusion: Dose-escalated image-guided radiotherapy strategies using these CT-PET guidedfunctional volumes have the potential to improve loco-regional control inpatients with squamous cell carcinoma of the Head and Neck.CT-PET 18FDG volume delineation is intricately linked to the method andthreshold of delineation and the timing of the imaging.64Cu-ATSM is promising as a hypoxic radio-nuclide and warrants furtherinvestigation." @default.
• W48651747 created "2016-06-24" @default.
• W48651747 creator A5008177769 @default.
• W48651747 date "2010-06-28" @default.
• W48651747 modified "2023-09-26" @default.
• W48651747 title "CT-PET guided target delineation in head and neck cancer and implications for improved outcome" @default.
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