Pooled analysis of two prospective studies of association of tumor hypoxia and distant metastasis from HNSCC

Given the high rates of locoregional control after definitive management of head and neck squamous cell carcinoma (HNSCC), better methods are needed to project distant metastasis risk. Pooled analysis of two prospective trials at Memorial Sloan Kettering Cancer Center (New York, NY) evaluated the association of tumor hypoxia before and during chemoradiotherapy for HNSCC. Among 281 patients, persistent tumor hypoxia (assessed with ¹⁸F-fluoromisonidazole PET) was associated with a 3.5-fold increased risk of distant metastasis and a 2.7-fold increased risk of death. Conversely, all patients who were negative for pretreatment hypoxia remained free of distant metastasis. The authors conclude that hypoxia of ¹⁸F-fluoromisonidazole PET may serve as a clinical biomarker of distant metastasis risk for patients with HNSCC who are treated with chemoradiotherapy, and guide patient selection for escalated therapeutic strategies.