The role of PET imaging in overcoming radiobiological challenges in the treatment of advanced head and neck cancer

PurposeDespite the large variety of treatment methods available for the management of advanced head and neck carcinomas, these tumours remain highly challenging due to their aggressiveness and complex anatomical location. Among the treatment challenges associated with head and neck cancers, hypoxia and tumour repopulation during treatment are, most likely, the main reason for locoregional treatment failure. Whilst the number of techniques and predictive assays designed to assess the oxygenation status or the proliferative ability of tumours is rather large, they all come with drawbacks which limit their implementation as routine clinical procedures. Latest developments in the field of nuclear medicine have opened the road to new possibilities in functional imaging, thus overcoming some of the confines imposed by the more conventional techniques.Materials and methodsThe current paper presents the role of PET imaging as a quantitative evaluation tool for hypoxia status and proliferative ability of advanced head and neck tumours. Traditional as well as novel radioisotopes with high affinity towards hypoxia and proliferative tumour activity are presented and their pre-clinical/clinical results analysed.ResultsWhile the number of clinical studies which aimed to validate novel radiotracers for head and neck cancer is limited, a number of results show promising correlation between uptake/marker activity and treatment outcome.ConclusionThere is need for further studies and well designed clinical trials to obtain more conclusive results.