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Title: Positron Emission Tomography-Guided, Focal-Dose Escalation Using Intensity-Modulated Radiotherapy for Head and Neck Cancer

Abstract

Purpose: To assess the feasibility of intensity-modulated radiotherapy (IMRT) using positron emission tomography (PET)-guided dose escalation, and to determine the maximum tolerated dose in head and neck cancer. Methods and Materials: A Phase I clinical trial was designed to escalate the dose limited to the [{sup 18}-F]fluoro-2-deoxy-D-glucose positron emission tomography ({sup 18}F-FDG-PET)-delineated subvolume within the gross tumor volume. Positron emission tomography scanning was performed in the treatment position. Intensity-modulated radiotherapy with an upfront simultaneously integrated boost was employed. Two dose levels were planned: 25 Gy (level I) and 30 Gy (level II), delivered in 10 fractions. Standard IMRT was applied for the remaining 22 fractions of 2.16 Gy. Results: Between 2003 and 2005, 41 patients were enrolled, with 23 at dose level I, and 18 at dose level II; 39 patients completed the planned therapy. The median follow-up for surviving patients was 14 months. Two cases of dose-limiting toxicity occurred at dose level I (Grade 4 dermitis and Grade 4 dysphagia). One treatment-related death at dose level II halted the study. Complete response was observed in 18 of 21 (86%) and 13 of 16 (81%) evaluated patients at dose levels I and II (p < 0.7), respectively, with actuarial 1-yearmore » local control at 85% and 87% (p n.s.), and 1-year overall survival at 82% and 54% (p = 0.06), at dose levels I and II, respectively. In 4 of 9 patients, the site of relapse was in the boosted {sup 18}F-FDG-PET-delineated region. Conclusions: For head and neck cancer, PET-guided dose escalation appears to be well-tolerated. The maximum tolerated dose was not reached at the investigated dose levels.« less

Authors:
 [1];  [2];  [2];  [2];  [2];  [2];  [2];  [3];  [3];  [2];  [2];  [4];  [5];  [6];  [7];  [2]
  1. Department of Radiotherapy, Ghent University Hospital, Ghent (Belgium). E-mail: indira@krtkg1.ugent.be
  2. Department of Radiotherapy, Ghent University Hospital, Ghent (Belgium)
  3. Department of Radiation Oncology and Center for Molecular Imaging and Experimental Radiotherapy, Universite Catholique de Louvain, St.-Luc University Hospital, Brussels (Belgium)
  4. (Belgium)
  5. Department of Radiology, Ghent University Hospital, Ghent (Belgium)
  6. Department of Head and Neck Surgery, Ghent University Hospital, Ghent (Belgium)
  7. Department of Medical Physics, Ghent University, Ghent (Belgium)
Publication Date:
OSTI Identifier:
20951623
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 68; Journal Issue: 1; Other Information: DOI: 10.1016/j.ijrobp.2006.12.070; PII: S0360-3016(07)00096-X; Copyright (c) 2007 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; CLINICAL TRIALS; DEATH; FLUORINE 18; GLUCOSE; HEAD; NECK; PATIENTS; POSITRON COMPUTED TOMOGRAPHY; RADIATION DOSES; RADIOTHERAPY; TOXICITY

Citation Formats

Madani, Indira, Duthoy, Wim, Derie, Cristina R.N., De Gersem, Werner Ir., Boterberg, Tom, Saerens, Micky, Jacobs, Filip Ir., Gregoire, Vincent, Lonneux, Max, Vakaet, Luc, Vanderstraeten, Barbara, Department of Medical Physics, Ghent University, Ghent, Bauters, Wouter, Bonte, Katrien, Thierens, Hubert, and Neve, Wilfried de. Positron Emission Tomography-Guided, Focal-Dose Escalation Using Intensity-Modulated Radiotherapy for Head and Neck Cancer. United States: N. p., 2007. Web. doi:10.1016/j.ijrobp.2006.12.070.
Madani, Indira, Duthoy, Wim, Derie, Cristina R.N., De Gersem, Werner Ir., Boterberg, Tom, Saerens, Micky, Jacobs, Filip Ir., Gregoire, Vincent, Lonneux, Max, Vakaet, Luc, Vanderstraeten, Barbara, Department of Medical Physics, Ghent University, Ghent, Bauters, Wouter, Bonte, Katrien, Thierens, Hubert, & Neve, Wilfried de. Positron Emission Tomography-Guided, Focal-Dose Escalation Using Intensity-Modulated Radiotherapy for Head and Neck Cancer. United States. doi:10.1016/j.ijrobp.2006.12.070.
Madani, Indira, Duthoy, Wim, Derie, Cristina R.N., De Gersem, Werner Ir., Boterberg, Tom, Saerens, Micky, Jacobs, Filip Ir., Gregoire, Vincent, Lonneux, Max, Vakaet, Luc, Vanderstraeten, Barbara, Department of Medical Physics, Ghent University, Ghent, Bauters, Wouter, Bonte, Katrien, Thierens, Hubert, and Neve, Wilfried de. Tue . "Positron Emission Tomography-Guided, Focal-Dose Escalation Using Intensity-Modulated Radiotherapy for Head and Neck Cancer". United States. doi:10.1016/j.ijrobp.2006.12.070.
@article{osti_20951623,
title = {Positron Emission Tomography-Guided, Focal-Dose Escalation Using Intensity-Modulated Radiotherapy for Head and Neck Cancer},
author = {Madani, Indira and Duthoy, Wim and Derie, Cristina R.N. and De Gersem, Werner Ir. and Boterberg, Tom and Saerens, Micky and Jacobs, Filip Ir. and Gregoire, Vincent and Lonneux, Max and Vakaet, Luc and Vanderstraeten, Barbara and Department of Medical Physics, Ghent University, Ghent and Bauters, Wouter and Bonte, Katrien and Thierens, Hubert and Neve, Wilfried de},
abstractNote = {Purpose: To assess the feasibility of intensity-modulated radiotherapy (IMRT) using positron emission tomography (PET)-guided dose escalation, and to determine the maximum tolerated dose in head and neck cancer. Methods and Materials: A Phase I clinical trial was designed to escalate the dose limited to the [{sup 18}-F]fluoro-2-deoxy-D-glucose positron emission tomography ({sup 18}F-FDG-PET)-delineated subvolume within the gross tumor volume. Positron emission tomography scanning was performed in the treatment position. Intensity-modulated radiotherapy with an upfront simultaneously integrated boost was employed. Two dose levels were planned: 25 Gy (level I) and 30 Gy (level II), delivered in 10 fractions. Standard IMRT was applied for the remaining 22 fractions of 2.16 Gy. Results: Between 2003 and 2005, 41 patients were enrolled, with 23 at dose level I, and 18 at dose level II; 39 patients completed the planned therapy. The median follow-up for surviving patients was 14 months. Two cases of dose-limiting toxicity occurred at dose level I (Grade 4 dermitis and Grade 4 dysphagia). One treatment-related death at dose level II halted the study. Complete response was observed in 18 of 21 (86%) and 13 of 16 (81%) evaluated patients at dose levels I and II (p < 0.7), respectively, with actuarial 1-year local control at 85% and 87% (p n.s.), and 1-year overall survival at 82% and 54% (p = 0.06), at dose levels I and II, respectively. In 4 of 9 patients, the site of relapse was in the boosted {sup 18}F-FDG-PET-delineated region. Conclusions: For head and neck cancer, PET-guided dose escalation appears to be well-tolerated. The maximum tolerated dose was not reached at the investigated dose levels.},
doi = {10.1016/j.ijrobp.2006.12.070},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 1,
volume = 68,
place = {United States},
year = {Tue May 01 00:00:00 EDT 2007},
month = {Tue May 01 00:00:00 EDT 2007}
}