Single-Center Prospective Trial Investigating the Feasibility of Serial FDG-PET Guided Adaptive Radiation Therapy for Head and Neck Cancer
| Autor: | Matthew D. La Fontaine, Zeno A R Gouw, Jan-Jakob Sonke, Wouter V. Vogel, Jeroen B. van de Kamer, Abrahim Al-Mamgani |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Larynx
Cancer Research medicine.medical_specialty medicine.medical_treatment Single Center 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Fluorodeoxyglucose F18 Positron Emission Tomography Computed Tomography medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies Laryngeal Neoplasms Aged Hypopharyngeal Neoplasms Radiation Squamous Cell Carcinoma of Head and Neck business.industry Head and neck cancer Radiotherapy Dosage Common Terminology Criteria for Adverse Events Middle Aged medicine.disease Dysphagia Primary tumor Radiation therapy Oropharyngeal Neoplasms medicine.anatomical_structure Oncology Head and Neck Neoplasms Prospective trial 030220 oncology & carcinogenesis Feasibility Studies Radiotherapy Intensity-Modulated Radiology Radiopharmaceuticals medicine.symptom business Radiotherapy Image-Guided |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 108:960-968 |
| ISSN: | 0360-3016 |
| Popis: | Purpose We investigated in a single-center prospective trial (NCT03376386) the use of serial fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) to determine the boost dose and to guide boost segmentation in head and neck cancer. Methods and Materials Patients were eligible when treated with curative radiation therapy with or without systemic treatment for T2-4 squamous cell carcinoma of the hypopharynx, larynx, or oropharynx (20 patients in total). FDG-PET/CT scans were made at baseline and for redelineation and replanning at the end of weeks 2 and 4 of radiation therapy. The metabolically active part of the primary tumor received a 4 Gy boost on top of the 70 Gy baseline dose per partial metabolic response. The study would be considered feasible when ≥80% of adaptations were successful and no Common Terminology Criteria for Adverse Events grade ≥4 acute toxicity occurred. Results One patient received 70 Gy after complete metabolic response in week 2, and 12 patients received 78 Gy because of partial metabolic response at weeks 2 and 4. Seven patients received 74 Gy, either because of complete metabolic response at week 4 (n = 3) or a missed FDG-PET/CT (n = 4). The patients missed their FDG-PET/CT scans because they did not fast (n = 2) or at patients’ request (n = 2). In addition to the 4 missed FDG-PET/CT scans, 2 adaptive plans could not be finished successfully owing to logistical problems. In total, 85% of adaptations were completed correctly. No patient experienced grade ≥4 toxicity, and 40% had grade 3 dysphagia (tube feeding) during treatment. This decreased at 12 weeks posttreatment to 20%. Conclusions This prospective trial demonstrates the feasibility of serial FDG-PET/CT scans for dose escalation and patient selection. |
| Databáze: | OpenAIRE |
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