Fractionated Boron Neutron Capture Therapy in Locally Recurrent Head and Neck Cancer: A Prospective Phase I/II Trial

Autor: Wen Liang Lo, Yi-Wei Chen, Hong-Ming Liu, Shou Yen Kao, Shyh-Jen Wang, Ling-Wei Wang, Yuan-Hao Liu, Ching-Yin Ho, Fong-In Chou, Jinn-Jer Peir, Pen-Yuan Chu, Yen-Wan Hsueh Liu, Chi-Wei Chang, Ko-Han Lin, Ching-Sheng Liu, Sang-Hue Yen, S.H. Jiang
Rok vydání: 2016
Předmět:
Adult
Boron Compounds
Carotid Artery Diseases
Male
Cancer Research
Dose-volume histogram
Time Factors
Phenylalanine
medicine.medical_treatment
Boron Neutron Capture Therapy
Hemorrhage
030218 nuclear medicine & medical imaging
03 medical and health sciences
0302 clinical medicine
medicine
Mucositis
Humans
Radiology
Nuclear Medicine and imaging
Prospective Studies
Prospective cohort study
Aged
Photons
Stomatitis
Radiation
business.industry
Head and neck cancer
Dose fractionation
Common Terminology Criteria for Adverse Events
Laryngeal Edema
Middle Aged
medicine.disease
Radiation therapy
Treatment Outcome
Oncology
Head and Neck Neoplasms
Response Evaluation Criteria in Solid Tumors
030220 oncology & carcinogenesis
Female
Dose Fractionation
Radiation
Neoplasm Recurrence
Local
business
Nuclear medicine
Follow-Up Studies
Zdroj: International Journal of Radiation Oncology*Biology*Physics. 95:396-403
ISSN: 0360-3016
DOI: 10.1016/j.ijrobp.2016.02.028
Popis: Purpose To investigate the efficacy and safety of fractionated boron neutron capture therapy (BNCT) for recurrent head and neck (H&N) cancer after photon radiation therapy. Methods and Materials In this prospective phase 1/2 trial, 2-fraction BNCT with intravenous L-boronophenylalanine (L-BPA, 400 mg/kg) was administered at a 28-day interval. Before each fraction, fluorine-18-labeled-BPA–positron emission tomography was conducted to determine the tumor/normal tissue ratio of an individual tumor. The prescription dose (D80) of 20 Gy-Eq per fraction was selected to cover 80% of the gross tumor volume by using a dose volume histogram, while minimizing the volume of oral mucosa receiving >10 Gy-Eq. Tumor responses and adverse effects were assessed using the Response Evaluation Criteria in Solid Tumors v1.1 and the Common Terminology Criteria for Adverse Events v3.0, respectively. Results Seventeen patients with a previous cumulative radiation dose of 63-165 Gy were enrolled. All but 2 participants received 2 fractions of BNCT. The median tumor/normal tissue ratio was 3.4 for the first fraction and 2.5 for the second, whereas the median D80 for the first and second fraction was 19.8 and 14.6 Gy-Eq, respectively. After a median follow-up period of 19.7 months (range, 5.2-52 mo), 6 participants exhibited a complete response and 6 exhibited a partial response. Regarding acute toxicity, 5 participants showed grade 3 mucositis and 1 participant showed grade 4 laryngeal edema and carotid hemorrhage. Regarding late toxicity, 2 participants exhibited grade 3 cranial neuropathy. Four of six participants (67%) receiving total D80 > 40 Gy-Eq had a complete response. Two-year overall survival was 47%. Two-year locoregional control was 28%. Conclusions Our results suggested that 2-fraction BNCT with adaptive dose prescription was effective and safe in locally recurrent H&N cancer. Modifications to our protocol may yield more satisfactory results in the future.
Databáze: OpenAIRE
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