18F-fluorodeoxythymidine micro-positron-emission tomography versus 18F-fluorodeoxyglucose micro-positron-emission tomography for in vivo minimal residual disease imaging.

Abstract

The early detection of persistent/recurrent disease of head and neck squamous cell carcinoma (HNSCC) after treatment can be challenging. The currently used radioisotope (18)F-fluorodeoxyglucose (FDG) is a nonspecific tracer for cancer cells as it detects all metabolically active cells including inflammation. (18)F-fluorodeoxythymidine (FLT) is a radioactive tracer for rapidly proliferating cells, and therefore is more specific for detecting cancer. Our aim was to compare FLT and FDG microPET (positron-emission tomography) to the gold standard in vivo bioluminescence imaging for serial assessment of neoplastic growth in a minimal residual disease in vivo model. Prospective outcomes research. In order to mimic the postsurgical environment of HNSCC patients FaDu cells transfected with a luciferase-expressing retrovirus were inoculated into the skin flap of Balb/c nu/nu mice. Three days later before tumors formed, mice were randomized into (18)F-FLT or (18) F-FDG groups, and microPET imaging was performed on days 3, 6, 10, 18, and 24 after tumor cell inoculation. (18)F-FLT detected tumors as early as day 3 even before tumors were palpable, whereas (18)F-FDG only detected palpable tumors. The average overall normalized radioactivity in the FLT group was significantly higher than the FDG group (P = .025). (18)F-FLT identified tumor cells before tumors were palpable and can potentially be used for early detection of persistence/recurrence of HNSCC. In addition, this radioisotope can be used to monitor adjuvant therapy with novel targeted therapeutics in preclinical models of persistent disease.