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Title: 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

Abstract

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{sup +}) oropharyngeal cancer (OPC) patients can safely receive radiation de-escalation without jeopardizing treatment outcomes. Methods and Materials: Patients with HPV{sup +} 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 {sup 18}F-fluorodeoxyglucose and dynamic {sup 18}F-FMISO (fluoromisonidazole) positron emission tomography (PET) scans were performed. For patients with pretreatment hypoxia on{sup 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{sup +} OPC patients were enrolled in this pilot study. Onemore » 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 {sup 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{sup +} 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.« less

Authors:
 [1];  [2];  [3]; ; ;  [1];  [4];  [5]; ; ;  [1];  [6]; ; ;  [7]; ; ; ;  [8];  [3]
  1. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)
  2. Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)
  3. Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)
  4. Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)
  5. Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)
  6. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)
  7. Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)
  8. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)
Publication Date:
OSTI Identifier:
22648775
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 96; Journal Issue: 1; Other Information: Copyright (c) 2016 Elsevier Science B.V., Amsterdam, The 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; ANOXIA; AZOLES; BIOMEDICAL RADIOGRAPHY; CHEMOTHERAPY; GY RANGE 10-100; IMAGES; LYMPH NODES; NEOPLASMS; PATIENTS; POSITRON COMPUTED TOMOGRAPHY; RADIATION DOSES; RADIOTHERAPY

Citation Formats

Lee, Nancy, E-mail: leen2@mskcc.org, Schoder, Heiko, Beattie, Brad, Lanning, Ryan, Riaz, Nadeem, McBride, Sean, Katabi, Nora, Li, Duan, Yarusi, Brett, Chan, Susie, Mitrani, Lindsey, Zhang, Zhigang, Pfister, David G., Sherman, Eric, Baxi, Shrujal, Boyle, Jay, Morris, Luc G.T., Ganly, Ian, Wong, Richard, and Humm, John. 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. United States: N. p., 2016. Web. doi:10.1016/J.IJROBP.2016.04.027.
Lee, Nancy, E-mail: leen2@mskcc.org, Schoder, Heiko, Beattie, Brad, Lanning, Ryan, Riaz, Nadeem, McBride, Sean, Katabi, Nora, Li, Duan, Yarusi, Brett, Chan, Susie, Mitrani, Lindsey, Zhang, Zhigang, Pfister, David G., Sherman, Eric, Baxi, Shrujal, Boyle, Jay, Morris, Luc G.T., Ganly, Ian, Wong, Richard, & Humm, John. 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. United States. doi:10.1016/J.IJROBP.2016.04.027.
Lee, Nancy, E-mail: leen2@mskcc.org, Schoder, Heiko, Beattie, Brad, Lanning, Ryan, Riaz, Nadeem, McBride, Sean, Katabi, Nora, Li, Duan, Yarusi, Brett, Chan, Susie, Mitrani, Lindsey, Zhang, Zhigang, Pfister, David G., Sherman, Eric, Baxi, Shrujal, Boyle, Jay, Morris, Luc G.T., Ganly, Ian, Wong, Richard, and Humm, John. Thu . "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". United States. doi:10.1016/J.IJROBP.2016.04.027.
@article{osti_22648775,
title = {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},
author = {Lee, Nancy, E-mail: leen2@mskcc.org and Schoder, Heiko and Beattie, Brad and Lanning, Ryan and Riaz, Nadeem and McBride, Sean and Katabi, Nora and Li, Duan and Yarusi, Brett and Chan, Susie and Mitrani, Lindsey and Zhang, Zhigang and Pfister, David G. and Sherman, Eric and Baxi, Shrujal and Boyle, Jay and Morris, Luc G.T. and Ganly, Ian and Wong, Richard and Humm, John},
abstractNote = {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{sup +}) oropharyngeal cancer (OPC) patients can safely receive radiation de-escalation without jeopardizing treatment outcomes. Methods and Materials: Patients with HPV{sup +} 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 {sup 18}F-fluorodeoxyglucose and dynamic {sup 18}F-FMISO (fluoromisonidazole) positron emission tomography (PET) scans were performed. For patients with pretreatment hypoxia on{sup 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{sup +} 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 {sup 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{sup +} 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.},
doi = {10.1016/J.IJROBP.2016.04.027},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 1,
volume = 96,
place = {United States},
year = {Thu Sep 01 00:00:00 EDT 2016},
month = {Thu Sep 01 00:00:00 EDT 2016}
}