Imaging hypoxia for head and neck cancer: current status, challenges, and prospects

Hypoxia can substantially impact clinical outcomes in patients with head and neck cancer (HNC) by promoting tumor invasion, metastasis, immune escape, and therapy resistance. Given the growing interest in targeting hypoxia for cancer therapy, noninvasive methods are needed to accurately detect hypoxia and evaluate the tumor response to treatment. This review summarizes recent advances in hypoxia-targeted probes and imaging techniques, emphasizing their imaging mechanisms, strengths, and limitations. We focused on the promising clinical applications of hypoxia imaging, especially those currently used in clinics, such as positron emission tomography and magnetic resonance imaging, and highlighted their roles in guiding personalized therapy. Future directions include optimizing imaging probes to improve safety profiles, integrating multimodal imaging, applying machine learning models to analyze multiparametric data, and establishing standardized 3-dimensional in vitro models to better mimic hypoxia heterogeneity. These advancements are expected to considerably improve the management of patients with HNC.