Simon Boeke1,2, Daniela Thorwarth2,3, David Mönnich2,3, Christina Pfannenberg4, Gerald Reischl5, Christian La Fougère6, Konstantin Nikolaou4, Paul-Stefan Mauz7, Frank Paulsen1, Daniel Zips1,3, Stefan Welz1. 1. a Department of Radiation Oncology , University Hospital and Medical Faculty, Eberhard Karls University Tübingen , Tübingen , Germany. 2. b Department of Radiation Oncology, Section for Biomedical Physics , University Hospital and Medical Faculty, Eberhard Karls University Tübingen , Tübingen , Germany. 3. c German Cancer Consortium (DKTK), Partner Site Tübingen; and German Cancer Research Center (DKFZ) , Heidelberg , Germany. 4. d Department of Diagnostic and Interventional Radiology , University Hospital and Medical Faculty, Eberhard Karls University Tübingen , Tübingen , Germany. 5. e Department of Preclinical Imaging and Radiopharmacy, Division of Radiology , University Hospital and Medical Faculty, Eberhard Karls University Tübingen , Tübingen , Germany. 6. f Department of Nuclear Medicine, Division of Radiology , University Hospital and Medical Faculty, Eberhard Karls University Tübingen , Tübingen , Germany. 7. g Department of Otorhinolaryngology - Head and Neck Surgery , University Hospital and Medical Faculty, Eberhard Karls University Tübingen , Tübingen , Germany.
Abstract
INTRODUCTION: A previous pattern-of-failure study has suggested that up to 50% of the loco-regional failures (LRF) in head and neck squamous cell carcinoma (HNSCC) occur outside the initial hypoxic volume determined by [18F]-fluoromisonidazole-PET ([18F]-FMISO-PET). The aim of the present analysis was to correlate spatial patterns of failure with respect to the pretherapeutic dynamic [18F]-FMISO-PET/CT in HNSCC after radiochemotherapy (RCT). MATERIAL AND METHODS: Within a running phase 2 trial using [18F]-FMISO-PET imaging prior to RCT in HNSCC patients (n = 54), we have observed so far 11 LRF with a minimum follow-up of 12 months. For nine patients, LRF imaging (CT or [18F]-FDG-PET/CT) for pattern-of-failure analysis was available. Analysis included the static 4-h hypoxic subvolume (VH) as well as a M-parameter volume (VM), which is derived from modeling of dynamic PET. Deformable image registration of the CT scan with the recurrent tumor to the pre-treatment [18F]-FMISO-PET/CT and the planning CT was done to quantify the hypoxic subvolumes compared to the recurrent tumor volume. Moreover, a point-of-origin analysis was performed. RESULTS: A total of five local, two regional and two loco-regional recurrences were detected. After deformable image registration of the CT scan with the recurrent tumor to the pre-treatment [18F]-FMISO-PET/CT and the planning CT, a significant overlap of the recurrence volume with [18F]-FMISO-positive subvolumes in the initial gross tumor volume (GTV) was observed. Median overlap of 40.2%, range 9.4-100.0%, for VH and 49.0%, range 4.4-96.4%, for VM was calculated. The point-of-origin analysis showed median distances of 0.0 mm, range 0.0-11.3 mm to VH and 8.6 mm, range 0.0-15.5 mm to VM, respectively. CONCLUSIONS: Our data suggest that loco-regional recurrences after RCT originate from the initial GTV (primary tumor and/or lymph node metastases) containing hypoxic subvolumes, which supports the concept of hypoxia imaging-based dose escalation.
RCT Entities:
INTRODUCTION: A previous pattern-of-failure study has suggested that up to 50% of the loco-regional failures (LRF) in head and neck squamous cell carcinoma (HNSCC) occur outside the initial hypoxic volume determined by [18F]-fluoromisonidazole-PET ([18F]-FMISO-PET). The aim of the present analysis was to correlate spatial patterns of failure with respect to the pretherapeutic dynamic [18F]-FMISO-PET/CT in HNSCC after radiochemotherapy (RCT). MATERIAL AND METHODS: Within a running phase 2 trial using [18F]-FMISO-PET imaging prior to RCT in HNSCC patients (n = 54), we have observed so far 11 LRF with a minimum follow-up of 12 months. For nine patients, LRF imaging (CT or [18F]-FDG-PET/CT) for pattern-of-failure analysis was available. Analysis included the static 4-h hypoxic subvolume (VH) as well as a M-parameter volume (VM), which is derived from modeling of dynamic PET. Deformable image registration of the CT scan with the recurrent tumor to the pre-treatment [18F]-FMISO-PET/CT and the planning CT was done to quantify the hypoxic subvolumes compared to the recurrent tumor volume. Moreover, a point-of-origin analysis was performed. RESULTS: A total of five local, two regional and two loco-regional recurrences were detected. After deformable image registration of the CT scan with the recurrent tumor to the pre-treatment [18F]-FMISO-PET/CT and the planning CT, a significant overlap of the recurrence volume with [18F]-FMISO-positive subvolumes in the initial gross tumor volume (GTV) was observed. Median overlap of 40.2%, range 9.4-100.0%, for VH and 49.0%, range 4.4-96.4%, for VM was calculated. The point-of-origin analysis showed median distances of 0.0 mm, range 0.0-11.3 mm to VH and 8.6 mm, range 0.0-15.5 mm to VM, respectively. CONCLUSIONS: Our data suggest that loco-regional recurrences after RCT originate from the initial GTV (primary tumor and/or lymph node metastases) containing hypoxic subvolumes, which supports the concept of hypoxia imaging-based dose escalation.
Authors: Nicole Wiedenmann; Hatice Bunea; Hans C Rischke; Andrei Bunea; Liette Majerus; Lars Bielak; Alexey Protopopov; Ute Ludwig; Martin Büchert; Christian Stoykow; Nils H Nicolay; Wolfgang A Weber; Michael Mix; Philipp T Meyer; Jürgen Hennig; Michael Bock; Anca L Grosu Journal: Radiat Oncol Date: 2018-08-29 Impact factor: 3.481
Authors: Franziska Eckert; Kerstin Zwirner; Simon Boeke; Daniela Thorwarth; Daniel Zips; Stephan M Huber Journal: Front Immunol Date: 2019-03-12 Impact factor: 7.561