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Acta Oncol. 2017 Nov;56(11):1571-1576. doi: 10.1080/0284186X.2017.1372626. Epub 2017 Sep 11.

Geometric analysis of loco-regional recurrences in relation to pre-treatment hypoxia in patients with head and neck cancer.

Author information

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.

PMID:
28891398
DOI:
10.1080/0284186X.2017.1372626
[Indexed for MEDLINE]

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