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Positron emission tomography-guided, focal-dose escalation using intensity-modulated radiotherapy for head and neck cancer

Indira Madani UGent, WIM DUTHOY, CRISTINA DERIE UGent, Werner De Gersem UGent, Tom Boterberg UGent, Mickey SAERENS, FILIP JACOBS UGent, Vincent GREGOIRE, Max LONNEUX and Luc Vakaet UGent, et al. (2007) INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS. 68(1). p.126-135
abstract
Purpose: To assess the feasibility of intensity-modulated radiotherapy (IMRT) using positron emission tomography (PET)-guided dose escalation, and to determine the maximum tolerated dose in head and neck cancer. Methods and Materials: A Phase I clinical trial was designed to escalate the dose limited to the [(18)-F]fluoro-2-deoxy-D-glucose positron emission tomography (F-18-FDG-PET)-detineated subvolume within the gross tumor volume. Positron emission tomography scanning was performed in the treatment position. Intensity-modulated radiotherapy with an upfront simultaneously integrated boost was employed. Two dose levels were planned: 25 Gy (level 1) and 30 Gy (level H), delivered in 10 fractions. Standard IMRT was applied for the remaining 22 fractions of 2.16 Gy. Results: Between 2003 and 2005, 41 patients were enrolled, with 23 at dose level 1, and 18 at dose level 11; 39 patients completed the planned therapy. The median follow-up for surviving patients was 14 months. Two cases of dose-limiting toxicity occurred at dose level I (Grade 4 dermitis and Grade 4 dysphagia). One treatment-related death at dose level II halted the study. Complete response was observed in 18 of 21 (86%) and 13 of 16 (81%) evaluated patients at dose levels I and II (p < 0.7), respectively, with actuarial 1-year local control at 85% and 87% (p = n.s.), and 1-year overall survival at 82% and 54% (p = 0.06), at dose levels I and II, respectively. In 4 of 9 patients, the site of relapse was in the boosted F-18-FDG-PET-delineated region. Conclusions: For head and neck cancer, PET-guided dose escalation appears to be well-tolerated. The maximum tolerated dose was not reached at the investigated dose levels.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (proceedingsPaper)
publication status
published
subject
journal title
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
Int. J. Radiat. Oncol. Biol. Phys.
volume
68
issue
1
pages
126-135 pages
publisher
ELSEVIER SCIENCE INC
conference name
25th Congress of the European Society for Therapeutic Radiology and Oncology
conference location
Leipzig, Germany
conference start
2006-10-08
conference end
2006-10-12
Web of Science type
Proceedings Paper
Web of Science id
000246046000017
JCR category
RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
JCR impact factor
4.29 (2007)
JCR rank
6/86 (2007)
JCR quartile
1 (2007)
ISSN
0360-3016
DOI
10.1016/j.ijrobp.2006.12.070
language
English
UGent publication?
yes
classification
A1
id
413875
handle
http://hdl.handle.net/1854/LU-413875
date created
2007-06-28 10:10:00
date last changed
2010-01-06 10:48:11
@article{413875,
  abstract     = {Purpose: To assess the feasibility of intensity-modulated radiotherapy (IMRT) using positron emission tomography (PET)-guided dose escalation, and to determine the maximum tolerated dose in head and neck cancer.
Methods and Materials: A Phase I clinical trial was designed to escalate the dose limited to the [(18)-F]fluoro-2-deoxy-D-glucose positron emission tomography (F-18-FDG-PET)-detineated subvolume within the gross tumor volume. Positron emission tomography scanning was performed in the treatment position. Intensity-modulated radiotherapy with an upfront simultaneously integrated boost was employed. Two dose levels were planned: 25 Gy (level 1) and 30 Gy (level H), delivered in 10 fractions. Standard IMRT was applied for the remaining 22 fractions of 2.16 Gy.

Results: Between 2003 and 2005, 41 patients were enrolled, with 23 at dose level 1, and 18 at dose level 11; 39 patients completed the planned therapy. The median follow-up for surviving patients was 14 months. Two cases of dose-limiting toxicity occurred at dose level I (Grade 4 dermitis and Grade 4 dysphagia). One treatment-related death at dose level II halted the study. Complete response was observed in 18 of 21 (86\%) and 13 of 16 (81\%) evaluated patients at dose levels I and II (p {\textlangle} 0.7), respectively, with actuarial 1-year local control at 85\% and 87\% (p = n.s.), and 1-year overall survival at 82\% and 54\% (p = 0.06), at dose levels I and II, respectively. In 4 of 9 patients, the site of relapse was in the boosted F-18-FDG-PET-delineated region.

Conclusions: For head and neck cancer, PET-guided dose escalation appears to be well-tolerated. The maximum tolerated dose was not reached at the investigated dose levels.},
  author       = {Madani, Indira and DUTHOY, WIM and DERIE, CRISTINA and De Gersem, Werner and Boterberg, Tom and SAERENS, Mickey and JACOBS, FILIP and GREGOIRE, Vincent and LONNEUX, Max and Vakaet, Luc and Vanderstraeten, Barbara and BAUTERS, WOUTER and BONTE, KATRIEN and Thierens, Hubert and De Neve, Wilfried},
  issn         = {0360-3016},
  journal      = {INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS},
  language     = {eng},
  location     = {Leipzig, Germany},
  number       = {1},
  pages        = {126--135},
  publisher    = {ELSEVIER SCIENCE INC},
  title        = {Positron emission tomography-guided, focal-dose escalation using intensity-modulated radiotherapy for head and neck cancer},
  url          = {http://dx.doi.org/10.1016/j.ijrobp.2006.12.070},
  volume       = {68},
  year         = {2007},
}

Chicago
Madani, Indira, WIM DUTHOY, CRISTINA DERIE, Werner De Gersem, Tom Boterberg, Mickey SAERENS, Filip Jacobs, et al. 2007. “Positron Emission Tomography-guided, Focal-dose Escalation Using Intensity-modulated Radiotherapy for Head and Neck Cancer.” International Journal of Radiation Oncology Biology Physics 68 (1): 126–135.
APA
Madani, I., DUTHOY, W., DERIE, C., De Gersem, W., Boterberg, T., SAERENS, M., Jacobs, F., et al. (2007). Positron emission tomography-guided, focal-dose escalation using intensity-modulated radiotherapy for head and neck cancer. INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 68(1), 126–135. Presented at the 25th Congress of the European Society for Therapeutic Radiology and Oncology.
Vancouver
1.
Madani I, DUTHOY W, DERIE C, De Gersem W, Boterberg T, SAERENS M, et al. Positron emission tomography-guided, focal-dose escalation using intensity-modulated radiotherapy for head and neck cancer. INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS. ELSEVIER SCIENCE INC; 2007;68(1):126–35.
MLA
Madani, Indira, WIM DUTHOY, CRISTINA DERIE, et al. “Positron Emission Tomography-guided, Focal-dose Escalation Using Intensity-modulated Radiotherapy for Head and Neck Cancer.” INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 68.1 (2007): 126–135. Print.