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Radiother Oncol. 2017 Aug;124(2):248-255. doi: 10.1016/j.radonc.2017.07.017. Epub 2017 Jul 31.

Patterns-of-failure guided biological target volume definition for head and neck cancer patients: FDG-PET and dosimetric analysis of dose escalation candidate subregions.

Author information

1
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Egypt.
2
Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA.
3
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
4
Department of Radiation Oncology, Case Western Reserve University, Cleveland, USA.
5
Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Egypt.
6
Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA.
7
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: cdfuller@mdanderson.org.
8
Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: MAristophanous@mdanderson.org.

Abstract

BACKGROUND:

To identify the radio-resistant subvolumes in pretreatment FDG-PET by mapping the spatial location of the origin of tumor recurrence after IMRT for head-and-neck squamous cell cancer to the pretreatment FDG-PET/CT.

METHODS:

Patients with local/regional recurrence after IMRT with available FDG-PET/CT and post-failure CT were included. For each patient, both pre-therapy PET/CT and recurrence CT were co-registered with the planning CT (pCT). A 4-mm radius was added to the centroid of mapped recurrence growth target volumes (rGTV's) to create recurrence nidus-volumes (NVs). The overlap between boost-tumor-volumes (BTV) representing different SUV thresholds/margins combinations and NVs was measured.

RESULTS:

Forty-seven patients were eligible. Forty-two (89.4%) had type A central high dose failure. Twenty-six (48%) of type A rGTVs were at the primary site and 28 (52%) were at the nodal site. The mean dose of type A rGTVs was 71Gy. BTV consisting of 50% of the maximum SUV plus 10mm margin was the best subvolume for dose boosting due to high coverage of primary site NVs (92.3%), low average relative volume to CTV1 (41%), and least average percent voxels outside CTV1 (19%).

CONCLUSIONS:

The majority of loco-regional recurrences originate in the regions of central-high-dose. When correlated with pretreatment FDG-PET, the majority of recurrences originated in an area that would be covered by additional 10mm margin on the volume of 50% of the maximum FDG uptake.

KEYWORDS:

Biological target volume; Dose escalation; FDG-PET; Head and neck cancer; Patterns of failure

PMID:
28774596
PMCID:
PMC5600500
DOI:
10.1016/j.radonc.2017.07.017
[Indexed for MEDLINE]
Free PMC Article

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