Yvonne M Mowery1, Irina Vergalasova2, Christel N Rushing3, Kingshuk Roy Choudhury3, Donna Niedzwiecki3, Qiuwen Wu4, David S Yoo4, Shiva Das5, Terence Z Wong6, David M Brizel7. 1. Department of Radiation Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina. Electronic address: yvonne.mowery@duke.edu. 2. Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey. 3. Duke Cancer Institute-Biostatistics, Duke University School of Medicine, Durham, North Carolina. 4. Department of Radiation Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina. 5. Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina. 6. Department of Radiology, Duke University School of Medicine, Durham, North Carolina. 7. Department of Radiation Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina; Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina.
Abstract
PURPOSE: Early indication of treatment outcome may guide therapeutic de-escalation strategies in patients with human papillomavirus (HPV)-related oropharyngeal cancer (OPC). This study investigated the relationships between tumor volume and 18F-fluorodeoxyglucose positron emission tomography (PET) parameters before and during definitive radiation therapy with treatment outcomes. METHODS AND MATERIALS: Patients undergoing definitive (chemo)radiation for HPV-related/p16-positive OPC were prospectively enrolled on an institutional review board-approved study. 18F-fluorodeoxyglucose PET/computed tomography scans were performed at simulation and after 2 weeks at a dose of ∼20 Gy. Tumor volume and standardized uptake value (SUV) characteristics were measured. SUV was normalized to blood pool uptake. Tumor volume and PET parameters associated with recurrence were identified through recursive partitioning (RPART). Recurrence-free survival (RFS) and overall survival (OS) curves between RPART-identified cohorts were estimated using the Kaplan-Meier method, and Cox models were used to estimate the hazard ratios (HRs). RESULTS: From 2012 to 2016, 62 patients with HPV-related OPC were enrolled. Median follow-up was 4.4 years. RPART identified patients with intratreatment SUVmax (normalized to blood pool SUVmean) <6.7 or SUVmax (normalized to blood pool SUVmean) ≥6.7 with intratreatment SUV40% ≥2.75 as less likely to recur. For identified subgroups, results of Cox models showed unadjusted HRs for RFS and OS (more likely to recur vs less likely) of 7.33 (90% confidence interval [CI], 2.97-18.12) and 6.09 (90% CI, 2.22-16.71), respectively, and adjusted HRs of 6.57 (90% CI, 2.53-17.05) and 5.61 (90% CI, 1.90-16.54) for RFS and OS, respectively. CONCLUSIONS: PET parameters after 2 weeks of definitive radiation therapy for HPV-related OPC are associated with RFS and OS, thus potentially informing an adaptive treatment approach.
PURPOSE: Early indication of treatment outcome may guide therapeutic de-escalation strategies in patients with human papillomavirus (HPV)-related oropharyngeal cancer (OPC). This study investigated the relationships between tumor volume and 18F-fluorodeoxyglucose positron emission tomography (PET) parameters before and during definitive radiation therapy with treatment outcomes. METHODS AND MATERIALS: Patients undergoing definitive (chemo)radiation for HPV-related/p16-positive OPC were prospectively enrolled on an institutional review board-approved study. 18F-fluorodeoxyglucose PET/computed tomography scans were performed at simulation and after 2 weeks at a dose of ∼20 Gy. Tumor volume and standardized uptake value (SUV) characteristics were measured. SUV was normalized to blood pool uptake. Tumor volume and PET parameters associated with recurrence were identified through recursive partitioning (RPART). Recurrence-free survival (RFS) and overall survival (OS) curves between RPART-identified cohorts were estimated using the Kaplan-Meier method, and Cox models were used to estimate the hazard ratios (HRs). RESULTS: From 2012 to 2016, 62 patients with HPV-related OPC were enrolled. Median follow-up was 4.4 years. RPART identified patients with intratreatment SUVmax (normalized to blood pool SUVmean) <6.7 or SUVmax (normalized to blood pool SUVmean) ≥6.7 with intratreatment SUV40% ≥2.75 as less likely to recur. For identified subgroups, results of Cox models showed unadjusted HRs for RFS and OS (more likely to recur vs less likely) of 7.33 (90% confidence interval [CI], 2.97-18.12) and 6.09 (90% CI, 2.22-16.71), respectively, and adjusted HRs of 6.57 (90% CI, 2.53-17.05) and 5.61 (90% CI, 1.90-16.54) for RFS and OS, respectively. CONCLUSIONS: PET parameters after 2 weeks of definitive radiation therapy for HPV-related OPC are associated with RFS and OS, thus potentially informing an adaptive treatment approach.
Authors: Yue Cao; Catherine T Haring; Michelle Mierzwa; J Chad Brenner; Collin Brummel; Chandan Bhambhani; Madhava Aryal; Choonik Lee; Molly Heft Neal; Apurva Bhangale; Wenjin Gu; Keith Casper; Kelly Malloy; Yilun Sun; Andrew Shuman; Mark E Prince; Matthew E Spector; Steven Chinn; Jennifer Shah; Caitlin Schonewolf; Jonathan B McHugh; Ryan E Mills; Muneesh Tewari; Francis P Worden; Paul L Swiecicki Journal: Clin Cancer Res Date: 2021-10-26 Impact factor: 13.801
Authors: Hangjie Ji; Kyle Lafata; Yvonne Mowery; David Brizel; Andrea L Bertozzi; Fang-Fang Yin; Chunhao Wang Journal: Front Oncol Date: 2022-05-13 Impact factor: 5.738
Authors: Kyle J Lafata; Yushi Chang; Chunhao Wang; Yvonne M Mowery; Irina Vergalasova; Donna Niedzwiecki; David S Yoo; Jian-Guo Liu; David M Brizel; Fang-Fang Yin Journal: Med Phys Date: 2021-06-02 Impact factor: 4.506
Authors: N Patrik Brodin; Christian Velten; Jonathan Lubin; Jeremy Eichler; Shaoyu Zhu; Sneha Saha; Chandan Guha; Shalom Kalnicki; Wolfgang A Tomé; Madhur K Garg; Rafi Kabarriti Journal: Phys Imaging Radiat Oncol Date: 2022-02-22
Authors: S Connor; C Sit; M Anjari; M Lei; T Guerrero-Urbano; T Szyszko; G Cook; P Bassett; V Goh Journal: J Cancer Res Clin Oncol Date: 2021-06-22 Impact factor: 4.553