Single-Center Prospective Trial Investigating the Feasibility of Serial FDG-PET Guided Adaptive Radiation Therapy for Head and Neck Cancer

Gouw, Zeno A.R.; Fontaine, Matthew D. La; Vogel, Wouter V.; Kamer, Jeroen B. van de; Sonke, Jan‐Jakob; Al‐Mamgani, Abrahim

doi:10.1016/j.ijrobp.2020.04.030

Cited by 19 publications

(10 citation statements)

References 29 publications

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“…Second, there is the strategy of radiotherapy dose (de-)escalation during treatment. Several studies confirmed the feasibility of FDG-PET-guided "dose painting by numbers", where voxel-wise dose escalation is related to FDG-uptake to produce a non-uniform dose distribution [59][60][61] . Currently two randomized controlled phase II trials are investigating whether radiotherapy dose escalation based on interim FDG-PET/CT can improve loco-regional control compared to standard radiotherapy (NCT01341535 & NCT01504815).…”

Section: Pet-guided Adaptive Radiotherapymentioning

confidence: 89%

18F-FDG-PET/CT-guided radiotherapy of cervical lymph nodes in head and neck squamous cell carcinoma

Cox¹,

Bosch²,

Dijkema³

et al. 2021

JCMT

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The use of positron emission tomography with fluor-18-fluorodeoxyglucose (FDG-PET) in clinical practice for patients with head and neck squamous cell carcinoma (HNSCC) has expanded rapidly, with implications for diagnostic staging, radiotherapy planning, adaptive radiotherapy, and post-therapy evaluation. The implementation of FDG-PET/CT in radiation treatment planning not only has consequences for target volume definition and dose prescription but is also associated with an increased overall survival in patients with HNSCC. FDG-PET/CT-guided gradient dose prescription provides a window of opportunity for treatment de-intensification of the neck in order to decrease treatment-related toxicity without compromising oncological outcome. Further, interim FDG-PET/CT during radiotherapy can be useful to assess metabolic tumor response and enables opportunities for adaptive treatment strategies. The goals are to increase treatment effectivity in poor responders and reduce unnecessary toxicity in patients with good early tumor response. Further prospective trials investigating adaptive radiotherapy based on interim PET-evaluation are needed, especially regarding human papilloma virus-negative HNSCC and patients treated with primary radiotherapy.

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Section: Pet-guided Adaptive Radiotherapymentioning

confidence: 89%

18F-FDG-PET/CT-guided radiotherapy of cervical lymph nodes in head and neck squamous cell carcinoma

Cox¹,

Bosch²,

Dijkema³

et al. 2021

JCMT

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“…Based on a plethora of mostly retrospective single-center studies, FDG-PET parameters are considered significant prognostic and potentially predictive parameters for response to CRT in HNSCC. This is reflected by the use of high FDG uptake volumes for dose escalation in several trials ( 17 – 20 ). In a recent review article Clausen and colleagues argued that regarding its prognostic value FDG is beyond the exploratory phase; at the same time they found evidence for publication bias with potential overestimation of the prognostic effect size of FDG parameters in HNSCC ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

18F-Fluorodeoxyglucose Positron Emission Tomography of Head and Neck Cancer: Location and HPV Specific Parameters for Potential Treatment Individualization

Zschaeck

Weingärtner²,

Lombardo³

et al. 2022

Front. Oncol.

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Purpose18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is utilized for staging and treatment planning of head and neck squamous cell carcinomas (HNSCC). Some older publications on the prognostic relevance showed inconclusive results, most probably due to small study sizes. This study evaluates the prognostic and potentially predictive value of FDG-PET in a large multi-center analysis.MethodsOriginal analysis of individual FDG-PET and patient data from 16 international centers (8 institutional datasets, 8 public repositories) with 1104 patients. All patients received curative intent radiotherapy/chemoradiation (CRT) and pre-treatment FDG-PET imaging. Primary tumors were semi-automatically delineated for calculation of SUVmax, SUVmean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Cox regression analyses were performed for event-free survival (EFS), overall survival (OS), loco-regional control (LRC) and freedom from distant metastases (FFDM).ResultsFDG-PET parameters were associated with patient outcome in the whole cohort regarding clinical endpoints (EFS, OS, LRC, FFDM), in uni- and multivariate Cox regression analyses. Several previously published cut-off values were successfully validated. Subgroup analyses identified tumor- and human papillomavirus (HPV) specific parameters. In HPV positive oropharynx cancer (OPC) SUVmax was well suited to identify patients with excellent LRC for organ preservation. Patients with SUVmax of 14 or less were unlikely to develop loco-regional recurrence after definitive CRT. In contrast FDG PET parameters deliver only limited prognostic information in laryngeal cancer.ConclusionFDG-PET parameters bear considerable prognostic value in HNSCC and potential predictive value in subgroups of patients, especially regarding treatment de-intensification and organ-preservation. The potential predictive value needs further validation in appropriate control groups. Further research on advanced imaging approaches including radiomics or artificial intelligence methods should implement the identified cut-off values as benchmark routine imaging parameters.

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“…Although the results are better, in the subgroup analysis only 12% represented floor of the mouth tumors. Retrospective studies have shown that brachytherapy alone or in combination with EBRT can improve the local control rate from approximately 70% up to > 95% [ 15 , 16 , 25 ] in early stages. Decroix and Ghossein [ 29 ] reported outcomes in 602 patients with oral tongue tumors who underwent brachytherapy as a single-modality treatment or in combination with EBRT.…”

Section: Discussionmentioning

confidence: 99%

“…The adoption of intensity-modulated radiation therapy and the use of multimodality imaging for tumor volume definition and organ at risk delineation have improved the clinical outcomes of patients with head and neck tumors [ 14 ]. Brachytherapy in combination with external beam radiotherapy (EBRT) and chemotherapy is an effective technique that leads to local dose escalation over the possibilities of up-to-date EBRT technologies [ 15 , 16 ]. In technically infeasible cases, such as large tumors, patients low-performance status, and contraindications of invasive procedures, a new image-guided stereotactic radiotherapy technique is an alternative option.…”

Section: Introductionmentioning

confidence: 99%

Dose escalation in advanced floor of the mouth cancer: a pilot study using a combination of IMRT and stereotactic boost

et al. 2021

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Purpose We evaluated the efficiency and toxicity of stereotactic hypofractionated boost in combination with conventionally fractionated radiotherapy in the treatment of advanced floor of the mouth cancer. Methods Thirty-seven patients with advanced stage of the floor of the mouth cancer, histologically confirmed squamous cell carcinoma (p16 negative) ineligible for surgical treatment, were indicated for radiochemotherapy or hyperfractionated accelerated radiotherapy (HART). The radiotherapy protocol combined external beam radiotherapy (EBRT) and a stereotactic hypofractionated boost to the primary tumor. The dose delivered from EBRT was 70–72.5 Gy in 35/50 fractions. The hypofractionated boost followed with 10 Gy in two fractions. For the variables—tumor volume, stage and grade a multivariate analysis was performed to find the relationship between overall survival, local progression and metastasis. Toxicity was evaluated according to CTCAE scale version 4. Results After a median follow-up of 16 months, 23 patients (62%) achieved complete remission. The median time to local progression and metastasis was 7 months. Local control (LC) at 2 and 5-years was 70% and 62%, respectively. Progression-free survival (PFS) and overall survival (OS) were 57% and 49% at 2 years and 41% and 27% at 5 years, respectively. Statistical analysis revealed that larger tumors had worse overall survival and a greater chance of metastasis. Log-Rank GTV > 44 ccm (HR = 1.96; [95% CI (0.87; 4.38)]; p = 0.11). No boost-related severe acute toxicity was observed. Late osteonecrosis was observed in 3 patients (8%). Conclusion The combination of EBRT and stereotactic hypofractionated boost is safe and seems to be an effective option for dose escalation in patients with advanced floor of the mouth tumors who are ineligible for surgical treatment and require a non-invasive approach.

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Single-Center Prospective Trial Investigating the Feasibility of Serial FDG-PET Guided Adaptive Radiation Therapy for Head and Neck Cancer

Cited by 19 publications

References 29 publications

18F-FDG-PET/CT-guided radiotherapy of cervical lymph nodes in head and neck squamous cell carcinoma

18F-FDG-PET/CT-guided radiotherapy of cervical lymph nodes in head and neck squamous cell carcinoma

18F-Fluorodeoxyglucose Positron Emission Tomography of Head and Neck Cancer: Location and HPV Specific Parameters for Potential Treatment Individualization

Dose escalation in advanced floor of the mouth cancer: a pilot study using a combination of IMRT and stereotactic boost

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