Zeno A R Gouw1, Matthew D La Fontaine2, Wouter V Vogel3, Jeroen B van de Kamer2, Jan-Jakob Sonke2, Abrahim Al-Mamgani2. 1. Departments of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands. Electronic address: z.gouw@nki.nl. 2. Departments of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands. 3. Departments of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands.
Abstract
PURPOSE: We investigated in a single-center prospective trial (NCT03376386) the use of serial fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) to determine the boost dose and to guide boost segmentation in head and neck cancer. METHODS AND MATERIALS: Patients were eligible when treated with curative radiation therapy with or without systemic treatment for T2-4 squamous cell carcinoma of the hypopharynx, larynx, or oropharynx (20 patients in total). FDG-PET/CT scans were made at baseline and for redelineation and replanning at the end of weeks 2 and 4 of radiation therapy. The metabolically active part of the primary tumor received a 4 Gy boost on top of the 70 Gy baseline dose per partial metabolic response. The study would be considered feasible when ≥80% of adaptations were successful and no Common Terminology Criteria for Adverse Events grade ≥4 acute toxicity occurred. RESULTS: One patient received 70 Gy after complete metabolic response in week 2, and 12 patients received 78 Gy because of partial metabolic response at weeks 2 and 4. Seven patients received 74 Gy, either because of complete metabolic response at week 4 (n = 3) or a missed FDG-PET/CT (n = 4). The patients missed their FDG-PET/CT scans because they did not fast (n = 2) or at patients' request (n = 2). In addition to the 4 missed FDG-PET/CT scans, 2 adaptive plans could not be finished successfully owing to logistical problems. In total, 85% of adaptations were completed correctly. No patient experienced grade ≥4 toxicity, and 40% had grade 3 dysphagia (tube feeding) during treatment. This decreased at 12 weeks posttreatment to 20%. CONCLUSIONS: This prospective trial demonstrates the feasibility of serial FDG-PET/CT scans for dose escalation and patient selection.
PURPOSE: We investigated in a single-center prospective trial (NCT03376386) the use of serial fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) to determine the boost dose and to guide boost segmentation in head and neck cancer. METHODS AND MATERIALS: Patients were eligible when treated with curative radiation therapy with or without systemic treatment for T2-4 squamous cell carcinoma of the hypopharynx, larynx, or oropharynx (20 patients in total). FDG-PET/CT scans were made at baseline and for redelineation and replanning at the end of weeks 2 and 4 of radiation therapy. The metabolically active part of the primary tumor received a 4 Gy boost on top of the 70 Gy baseline dose per partial metabolic response. The study would be considered feasible when ≥80% of adaptations were successful and no Common Terminology Criteria for Adverse Events grade ≥4 acute toxicity occurred. RESULTS: One patient received 70 Gy after complete metabolic response in week 2, and 12 patients received 78 Gy because of partial metabolic response at weeks 2 and 4. Seven patients received 74 Gy, either because of complete metabolic response at week 4 (n = 3) or a missed FDG-PET/CT (n = 4). The patients missed their FDG-PET/CT scans because they did not fast (n = 2) or at patients' request (n = 2). In addition to the 4 missed FDG-PET/CT scans, 2 adaptive plans could not be finished successfully owing to logistical problems. In total, 85% of adaptations were completed correctly. No patient experienced grade ≥4 toxicity, and 40% had grade 3 dysphagia (tube feeding) during treatment. This decreased at 12 weeks posttreatment to 20%. CONCLUSIONS: This prospective trial demonstrates the feasibility of serial FDG-PET/CT scans for dose escalation and patient selection.
Authors: Sebastian Zschaeck; Julian Weingärtner; Elia Lombardo; Sebastian Marschner; Marina Hajiyianni; Marcus Beck; Daniel Zips; Yimin Li; Qin Lin; Holger Amthauer; Esther G C Troost; Jörg van den Hoff; Volker Budach; Jörg Kotzerke; Konstantinos Ferentinos; Efstratios Karagiannis; David Kaul; Vincent Gregoire; Adrien Holzgreve; Nathalie L Albert; Pavel Nikulin; Michael Bachmann; Klaus Kopka; Mechthild Krause; Michael Baumann; Joanna Kazmierska; Paulina Cegla; Witold Cholewinski; Iosif Strouthos; Klaus Zöphel; Ewa Majchrzak; Guillaume Landry; Claus Belka; Carmen Stromberger; Frank Hofheinz Journal: Front Oncol Date: 2022-06-08 Impact factor: 5.738