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Radiother Oncol. 2017 Sep;124(3):526-532. doi: 10.1016/j.radonc.2017.04.004. Epub 2017 Apr 20.

Prognostic value of dynamic hypoxia PET in head and neck cancer: Results from a planned interim analysis of a randomized phase II hypoxia-image guided dose escalation trial.

Author information

1
Department of Radiation Oncology, University of Tübingen, Germany.
2
Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Germany.
3
Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Germany.
4
Department of Nuclear Medicine, University of Tübingen, Germany.
5
Department of Preclinical Imaging and Radiopharmacy, University of Tübingen, Germany.
6
Department of Otorhinolaryngology, University of Tübingen, Germany.
7
Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Germany; Department of Radiation Oncology, University of Heidelberg, Germany.
8
Department of Radiation Oncology, University of Tübingen, Germany; Department of Radiation Oncology, LMU Munich, Germany.
9
Department of Radiation Oncology, University of Tübingen, Germany; German Cancer Consortium (DKTK), partner site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany.
10
Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Germany; German Cancer Consortium (DKTK), partner site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany. Electronic address: daniela.thorwarth@med.uni-tuebingen.de.

Abstract

BACKGROUND AND PURPOSE:

To prospectively assess the prognostic value of tumour hypoxia determined by dynamic [18F]Fluoromisonidazole (dynFMISO) PET/CT, and to evaluate both feasibility and toxicity in patients with locally advanced squamous cell carcinomas of the head and neck (LASCCHN) treated with dynFMISO image-guided dose escalation (DE) using dose-painting by contours.

PATIENTS AND METHODS:

We present a planned interim analysis of a randomized phase II trial. N=25 patients with LASCCHN received baseline dynFMISO PET/CT to derive hypoxic volumes (HV). Patients with tumour hypoxia were randomized into standard radiochemotherapy (stdRT) (70Gy/35 fractions) or DE (77Gy/35 fractions) to the HV. Patients with non-hypoxic tumours were treated with stdRT. Loco-regional control (LRC) in hypoxic patients randomized to stdRT was compared to non-hypoxic patients. Feasibility and toxicity were analysed for patients in the DE arm and compared to stdRT.

RESULTS:

With a mean follow-up of 27months, LRC in hypoxic patients receiving stdRT (n=10) was significantly worse compared to the non-hypoxic group (n=5) (2y-LRC 44.4% versus 100%, p=0.048). The respective LRC for the DE group (n=10) was 70.0%. Treatment compliance as well as acute and late toxicity did not show significant differences between the DE and the standard dose arms.

CONCLUSION:

Tumour hypoxia determined by baseline dynFMISO PET/CT is associated with a high risk of local failure in patients with LASCCHN. First data suggest that DE to HV is feasible without excess toxicity.

KEYWORDS:

Dose escalation; FMISO PET/CT; Head and neck cancer; Hypoxia; IMRT

Comment in

PMID:
28434798
DOI:
10.1016/j.radonc.2017.04.004
[Indexed for MEDLINE]

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