Anne K Due1, Ivan R Vogelius2, Marianne C Aznar3, Søren M Bentzen4, Anne K Berthelsen5, Stine S Korreman6, Annika Loft7, Claus A Kristensen1, Lena Specht1. 1. Department of Oncology, Rigshospitalet, University of Copenhagen, Denmark. 2. Department of Oncology, Rigshospitalet, University of Copenhagen, Denmark. Electronic address: ivan.storgaard.vogelius@rh.regionh.dk. 3. Department of Oncology, Rigshospitalet, University of Copenhagen, Denmark; Niels Bohr Institute, University of Copenhagen, Denmark. 4. Department of Oncology, Rigshospitalet, University of Copenhagen, Denmark; Department of Human Oncology, University of Wisconsin, Madison, United States; Greenebaum Cancer Center, Department of Epidemiology & Public Health, University of Maryland, Baltimore, United States. 5. Department of Oncology, Rigshospitalet, University of Copenhagen, Denmark; Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Denmark. 6. Niels Bohr Institute, University of Copenhagen, Denmark; Department of Science, Systems and Models, Roskilde University, Denmark. 7. Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Denmark.
Abstract
BACKGROUND AND PURPOSE: To analyze the recurrence pattern in relation to target volumes and (18)F-fluorodeoxyglucose (FDG) uptake on positron emission tomography in head and neck squamous cell carcinoma (HNSCC) patients treated with definitive chemoradiation. MATERIAL AND METHODS: 520 patients received radiotherapy for HNSCC from 2005 to 2009. Among 100 patients achieving complete clinical response and a later recurrence, 39 patients with 48 loco-regional failures had a recurrence CT scan before any salvage therapy. The estimated point of origin of each recurrence was transferred to the planning CT by deformable image co-registration. The recurrence position was then related to the delineated target volumes and iso-SUV-contours relative to the maximum standard uptake value (SUV). We defined the recurrence density as the total number of recurrences in a sub-volume divided by the sum of that volume for all patients. RESULTS: 54% (95% CI 37-69%) of recurrences originated inside the FDG-positive volume and 96% (95% CI 86-99%) in the high dose region. Recurrence density was significantly higher in the central target volumes (P<0.0001) and increased with increasing FDG avidity (P=0.036). CONCLUSIONS: The detailed pattern-of-failure data analysis suggests that most recurrences occur in the FDG PET positive areas or the solid tumor.
BACKGROUND AND PURPOSE: To analyze the recurrence pattern in relation to target volumes and (18)F-fluorodeoxyglucose (FDG) uptake on positron emission tomography in head and neck squamous cell carcinoma (HNSCC) patients treated with definitive chemoradiation. MATERIAL AND METHODS: 520 patients received radiotherapy for HNSCC from 2005 to 2009. Among 100 patients achieving complete clinical response and a later recurrence, 39 patients with 48 loco-regional failures had a recurrence CT scan before any salvage therapy. The estimated point of origin of each recurrence was transferred to the planning CT by deformable image co-registration. The recurrence position was then related to the delineated target volumes and iso-SUV-contours relative to the maximum standard uptake value (SUV). We defined the recurrence density as the total number of recurrences in a sub-volume divided by the sum of that volume for all patients. RESULTS: 54% (95% CI 37-69%) of recurrences originated inside the FDG-positive volume and 96% (95% CI 86-99%) in the high dose region. Recurrence density was significantly higher in the central target volumes (P<0.0001) and increased with increasing FDG avidity (P=0.036). CONCLUSIONS: The detailed pattern-of-failure data analysis suggests that most recurrences occur in the FDG PET positive areas or the solid tumor.
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