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

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

doi:10.1007/S00066-018-1293-3

Publication

Title

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

Author

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

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.

Language

English

Source (journal)

Strahlentherapie und Onkologie. - München

Publication

München : 2018

ISSN

0179-7158

Volume/pages

194 :8 (2018) , p. 727-736

ISI

000439933100004