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

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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.

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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.
@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},
}

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