Strategy of Using Intratreatment Hypoxia Imaging to Selectively and Safely Guide Radiation Dose De-escalation Concurrent With Chemotherapy for Locoregionally Advanced Human Papillomavirus–Related Oropharyngeal Carcinoma
| Autor: | Brad Beattie, Richard J. Wong, Ryan M. Lanning, Sean McBride, Nora Katabi, Heiko Schöder, John L. Humm, Duan Li, Brett Yarusi, Ian Ganly, Lindsey Mitrani, Shrujal S. Baxi, Nadeem Riaz, Luc G. T. Morris, David G. Pfister, Eric J. Sherman, Nancy Y. Lee, Jay O. Boyle, Susie Chan, Zhigang Zhang |
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| Rok vydání: | 2016 |
| Předmět: |
Cancer Research
medicine.medical_specialty medicine.medical_treatment 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine medicine Carcinoma Radiology Nuclear Medicine and imaging Lymph node Radiation Tumor hypoxia medicine.diagnostic_test business.industry Head and neck cancer Hypoxia (medical) medicine.disease Surgery Radiation therapy medicine.anatomical_structure Oncology Positron emission tomography 030220 oncology & carcinogenesis Radiology medicine.symptom business Chemoradiotherapy |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 96:9-17 |
| ISSN: | 0360-3016 |
| Popis: | Purpose To report a small substudy of an ongoing large, multi-arm study using functional imaging to assess pre-/intratreatment hypoxia for all head and neck cancer, in which we hypothesized that pre- and early-treatment hypoxia assessment using functional positron emission tomography (PET) imaging may help select which human papillomavirus (HPV)-positive (HPV + ) oropharyngeal cancer (OPC) patients can safely receive radiation de-escalation without jeopardizing treatment outcomes. Methods and Materials Patients with HPV + oropharyngeal carcinoma were enrolled on an institutional review board–approved prospective study of which de-escalation based on imaging response was done for node(s) only. Pretreatment 18 F-fluorodeoxyglucose and dynamic 18 F-FMISO (fluoromisonidazole) positron emission tomography (PET) scans were performed. For patients with pretreatment hypoxia on 18 F-FMISO PET (defined as a >1.2 tumor to muscle standard uptake value ratio), a repeat scan was done 1 week after chemoradiation. Patients without pretreatment hypoxia or with resolution of hypoxia on repeat scan received a 10-Gy dose reduction to metastatic lymph node(s). The 2-year local, regional, distant metastasis–free, and overall survival rates were estimated using the Kaplan-Meier product-limit method. A subset of patients had biopsy of a hypoxic node done under image guidance. Results Thirty-three HPV + OPC patients were enrolled in this pilot study. One hundred percent showed pretreatment hypoxia (at primary site and/or node[s]), and among these, 48% resolved (at primary site and/or node[s]); 30% met criteria and received 10-Gy reduction to the lymph node(s). At the median follow-up of 32 months (range, 21-61 months), the 2-year locoregional control rate was 100%. One patient failed distantly with persistence of hypoxia on 18 F-FMISO PET. The 2-year distant metastasis–free rate was 97%. The 2-year OS rate was 100%. Hypoxia on imaging was confirmed pathologically. Conclusions Hypoxia is present in HPV + tumors but resolves within 1 week of treatment in 48% of cases either at the primary site and/or lymph node(s). Our 100% locoregional control rate suggests that intratreatment functional imaging used to selectively de-escalate node(s) to 60 Gy was confirmed safe using our stringent imaging criteria. Intratreatment functional imaging warrants further study to determine its ultimate role in de-escalation treatment strategies. |
| Databáze: | OpenAIRE |
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