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

(2018) STRAHLENTHERAPIE UND ONKOLOGIE. 194(8). p.727-736
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Abstract
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.
Keywords
Reirradiation, Adaptive radiotherapy, F-18-FDG-PET, Dose painting, Head and neck tumors, SQUAMOUS-CELL CARCINOMA, INTENSITY-MODULATED RADIOTHERAPY, HIGH-DOSE REIRRADIATION, BODY RADIATION-THERAPY, PHASE-I TRIAL, CLINICAL-TRIAL, STEREOTACTIC REIRRADIATION, PLUS CETUXIMAB, NUMBERS, TOXICITY

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Citation

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MLA
Schatteman, Julie et al. “A Feasibility Study on Adaptive 18F-FDG-PET-guided Radiotherapy for Recurrent and Second Primary Head and Neck Cancer in the Previously Irradiated Territory.” STRAHLENTHERAPIE UND ONKOLOGIE 194.8 (2018): 727–736. Print.
APA
Schatteman, J., Van Gestel, D., Berwouts, D., De Gersem, W., De Kerf, G., De Neve, W., De Ost, B., et al. (2018). A feasibility study on adaptive 18F-FDG-PET-guided radiotherapy for recurrent and second primary head and neck cancer in the previously irradiated territory. STRAHLENTHERAPIE UND ONKOLOGIE, 194(8), 727–736.
Chicago author-date
Schatteman, Julie, Dirk Van Gestel, Dieter Berwouts, Werner De Gersem, Geert De Kerf, Wilfried De Neve, Bie De Ost, et al. 2018. “A Feasibility Study on Adaptive 18F-FDG-PET-guided Radiotherapy for Recurrent and Second Primary Head and Neck Cancer in the Previously Irradiated Territory.” Strahlentherapie Und Onkologie 194 (8): 727–736.
Chicago author-date (all authors)
Schatteman, Julie, Dirk Van Gestel, Dieter Berwouts, Werner De Gersem, Geert De Kerf, Wilfried De Neve, Bie De Ost, Ana Maria Luiza Olteanu, Sylvie Rottey, Tom Vercauteren, Ingeborg Goethals, and Fréderic Duprez. 2018. “A Feasibility Study on Adaptive 18F-FDG-PET-guided Radiotherapy for Recurrent and Second Primary Head and Neck Cancer in the Previously Irradiated Territory.” Strahlentherapie Und Onkologie 194 (8): 727–736.
Vancouver
1.
Schatteman J, Van Gestel D, Berwouts D, De Gersem W, De Kerf G, De Neve W, et al. A feasibility study on adaptive 18F-FDG-PET-guided radiotherapy for recurrent and second primary head and neck cancer in the previously irradiated territory. STRAHLENTHERAPIE UND ONKOLOGIE. 2018;194(8):727–36.
IEEE
[1]
J. Schatteman et al., “A feasibility study on adaptive 18F-FDG-PET-guided radiotherapy for recurrent and second primary head and neck cancer in the previously irradiated territory,” STRAHLENTHERAPIE UND ONKOLOGIE, vol. 194, no. 8, pp. 727–736, 2018.
@article{8565370,
  abstract     = {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.},
  author       = {Schatteman, Julie and Van Gestel, Dirk and Berwouts, Dieter and De Gersem, Werner and De Kerf, Geert and De Neve, Wilfried and De Ost, Bie and Olteanu, Ana Maria Luiza and Rottey, Sylvie and Vercauteren, Tom and Goethals, Ingeborg and Duprez, Fréderic},
  issn         = {0179-7158},
  journal      = {STRAHLENTHERAPIE UND ONKOLOGIE},
  keywords     = {Reirradiation,Adaptive radiotherapy,F-18-FDG-PET,Dose painting,Head and neck tumors,SQUAMOUS-CELL CARCINOMA,INTENSITY-MODULATED RADIOTHERAPY,HIGH-DOSE REIRRADIATION,BODY RADIATION-THERAPY,PHASE-I TRIAL,CLINICAL-TRIAL,STEREOTACTIC REIRRADIATION,PLUS CETUXIMAB,NUMBERS,TOXICITY},
  language     = {eng},
  number       = {8},
  pages        = {727--736},
  title        = {A feasibility study on adaptive 18F-FDG-PET-guided radiotherapy for recurrent and second primary head and neck cancer in the previously irradiated territory},
  url          = {http://dx.doi.org/10.1007/s00066-018-1293-3},
  volume       = {194},
  year         = {2018},
}

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