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World J Clin Oncol. Dec 10, 2014; 5(5): 824-844
Published online Dec 10, 2014. doi: 10.5306/wjco.v5.i5.824
Positron emission tomography to assess hypoxia and perfusion in lung cancer
Eline E Verwer, Ronald Boellaard, Astrid AM van der Veldt
Eline E Verwer, Ronald Boellaard, Department of Radiology and Nuclear Medicine, VU University Medical Center, 1007 MB, Amsterdam, The Netherlands
Astrid AM van der Veldt, Department of Internal Medicine, VU University Medical Center, 1007 MB, Amsterdam, The Netherlands
Author contributions: Verwer EE and van der Veldt AAM designed and wrote the review article; Boellaard R contributed substantially to the design of the article; all authors critically revised the manuscript and approved the final version for publication.
Supported by AIRFORCE Project, No. 03O-103
Correspondence to: Astrid AM van der Veldt, MD, PhD, Department of Internal Medicine, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. aam.vanderveldt@vumc.nl
Telephone: + 31-20-4444444 Fax: +31-20-4443090
Received: January 30, 2014
Revised: April 29, 2014
Accepted: July 15, 2014
Published online: December 10, 2014
Processing time: 315 Days and 7 Hours
Abstract

In lung cancer, tumor hypoxia is a characteristic feature, which is associated with a poor prognosis and resistance to both radiation therapy and chemotherapy. As the development of tumor hypoxia is associated with decreased perfusion, perfusion measurements provide more insight into the relation between hypoxia and perfusion in malignant tumors. Positron emission tomography (PET) is a highly sensitive nuclear imaging technique that is suited for non-invasive in vivo monitoring of dynamic processes including hypoxia and its associated parameter perfusion. The PET technique enables quantitative assessment of hypoxia and perfusion in tumors. To this end, consecutive PET scans can be performed in one scan session. Using different hypoxia tracers, PET imaging may provide insight into the prognostic significance of hypoxia and perfusion in lung cancer. In addition, PET studies may play an important role in various stages of personalized medicine, as these may help to select patients for specific treatments including radiation therapy, hypoxia modifying therapies, and antiangiogenic strategies. In addition, specific PET tracers can be applied for monitoring therapy. The present review provides an overview of the clinical applications of PET to measure hypoxia and perfusion in lung cancer. Available PET tracers and their characteristics as well as the applications of combined hypoxia and perfusion PET imaging are discussed.

Keywords: Molecular imaging; Positron emission tomography; Hypoxia; Perfusion; Quantification; Lung cancer

Core tip: This review provides an overview of the current applications of positron emission tomography for hypoxia and perfusion imaging in lung cancer. Available PET tracers are discussed and the benefits of combined hypoxia and perfusion PET imaging are clarified. Hypoxia imaging could aid in selecting patients for hypoxia-specific treatment strategies. To achieve this, consensus about the optimal imaging protocol and quantification method is essential. Large clinical trials are needed to confirm the value of hypoxia imaging for improving patient care.