A feasibility study on adaptive F-18-FDG-PET-guided radiotherapy for recurrent and second primary head and neck cancer in the previously irradiated territory

作者：Schatteman Julie^*; Van Gestel Dirk; Berwouts Dieter; De Gersem Werner; De Kerf Geert; De Neve Wilfried; De Ost Bie; Olteanu Ana Maria Luiza; Rottey Sylvie; Vercauteren Tom; Goethals Ingeborg; Duprez Frederic

来源：Strahlentherapie und Onkologie, 2018, 194(8): 727-736.

DOI：10.1007/s00066-018-1293-3

• Reirradiation
• Adaptive radiotherapy
• F-18-FDG-PET
• Dose painting
• Head and neck tumors

To evaluate feasibility, disease control, survival, and toxicity after adaptive F-18-fluorodeoxyglucose (FDG) positron emisson tomography (PET) guided radiotherapy in patients with recurrent and second primary head and neck squamous cell carcinoma.
A prospective trial investigated the feasibility of adaptive intensity modulated radiotherapy (IMRT)+/- concomitant cetuximab in 10 patients. The primary endpoint was achieving a 2-year survival free of grade > 3 toxicity in a 30% of patients. Three treatment plans based on 3 PET/CT scans were consecutively delivered in 6 weeks. The range of dose painting was 66.0-85.0Gy in the dose-painted tumoral volumes in 30 fractions.
Two-year locoregional and distant control rates were 38 and 76%, respectively. Overall and disease-free survival at 2 years was 20%. No grade 4 or 5 acute toxicity was observed in any of the patients, except for arterial mucosal hemorrhage in 1 patient. Three months after radiotherapy, grade 4 dysphagia and mucosal wound healing problems were observed in 1/7 and 1/6 of patients, respectively. Grade 5 toxicity (fatal bleeding) was seen in 2 patients, at 3.8 and 4.1 months of follow-up. Data on 2aEuroyear toxicity could only be assessed in 1 of the 2 surviving patients, in whom grade 4 mucosal wound healing problems were observed; no other grade > 3 toxicity was observed. In this respect, a 30% 2aEuroyear survival free of grade > 3 toxicity will not be achieved.
Adaptive PET-guided reirradiation is feasible. However, due to slow accrual and treatment results that seemed inconsistent with achieving the primary endpoint, the trial was stopped early.

• 出版日期2018-8