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Overall and disease-free survival outcomes of patients receiving intensity-modulated radiation therapy (IMRT) with PET-CT-based planning for cancers of the head and neck

Published online by Cambridge University Press:  30 April 2015

Benjamin L. Franc ,
Christi DeLemos  and
Christopher Jones
Benjamin L. Franc*
Affiliation:
Department of Diagnostic Imaging, Sutter Medical Group, Sacramento, CA, USA Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
Christi DeLemos
Affiliation:
Radiological Associates of Sacramento Medical Group, Sacramento, CA, USA
Christopher Jones
Affiliation:
Radiation Oncology Center, Sutter Medical Group, Sacramento, CA, USA
*
Correspondence to: Benjamin L. Franc, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, San Francisco, CA 94107, USA. Tel: 650 776 8080. E-mail: [email protected]
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Abstract

Introduction

Combined modality treatment regimens have provided modest gains in locoregional control rates of cancers of the head and neck (HNC), and intensity-modulated radiation therapy (IMRT) has gained widespread use. The methodology for determining contours of the gross tumour volume (GTV) in the radiation treatment plan is often based on combined anatomic and metabolic data from positron emission tomography–computed tomography (PET-CT). This study aimed to retrospectively evaluate the overall survival and disease-free survival outcomes of patients with HNC who received definitive IMRT with or without chemotherapy, planned with PET-CT.

Materials and Methods

A total of 1,200 patients underwent treatment for HNC during the study period, from 1 January 2002 to 31 December 2010. Of those, 261 cases had evaluable data that met the inclusion criteria for the study. The incidence and timing of locoregional recurrence, distant metastatic disease, new primary malignancies and death were evaluated retrospectively. Overall and disease-free survival (survival to time of first recurrence) were determined by the life table method. Incidence of distance metastatic disease and additional cancers were also studied.

Results

Median follow-up from treatment initiation was 26·4 months (range 1·2–84·7 months). Overall survival and disease-free survival rates were 0·883 and 0·791, respectively, at 1 year; 0·793 and 0·688, respectively, at 2 years; and 0·732 and 0·619, respectively, at 3 years. The cumulative risk of recurrence was 22·6% at 3 years following definitive IMRT and the median time to recurrence was 345 days. There was an overall low incidence of distant metastatic disease (3·07%) and additional cancers (8·05%).

Conclusion

Overall and disease-free survival outcomes of a large cohort of HNC patients treated with definitive IMRT radiotherapy following treatment planning with PET-CT shows a similar high level of disease control and mortality rate as previously published outcome studies of shorter terms and/or smaller numbers of patients.

Keywords

head and neck cancerintensity-modulated radiation therapy (IMRT)PET-CTsurvival
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 14 , Issue 3 , September 2015 , pp. 285 - 295
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Copyright
© Cambridge University Press 2015 

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References

1.Heron, D E, Andrade, R S, Beriwal, Set al. PET-CT in radiation oncology: the impact on diagnosis, treatment planning, and assessment of treatment response. Am J Clin Oncol 2008; 31 (4): 352–362.CrossRefGoogle ScholarPubMed
2.Ciernik, I F, Dizendorf, E, Baumert, B Get al. Radiation treatment planning with an integrated positron emission and computer tomography (PET/CT): a feasibility study. Int J Radiat Oncol Biol Phys 2003; 57 (3): 853–863.CrossRefGoogle ScholarPubMed
3.Deantonio, L, Beldi, D, Gambaro, Get al. FDG-PET/CT imaging for staging and radiotherapy treatment planning of head and neck carcinoma. Radiother Oncol 2008; 3: 29.Google ScholarPubMed
4.Heron, D E, Andrade, R S, Flickinger, Jet al. Hybrid PET-CT simulation for radiation treatment planning in head and neck cancers: a brief technical report. Int J Radiat Oncol Biol Phys 2004; 60: 1419–1424.CrossRefGoogle ScholarPubMed
5.Vernon, M R, Maheshwari, M, Schultz, C Jet al. Clinical outcomes of patients receiving integrated PET/CT-guided radiotherapy for head and neck carcinoma. Int J Radiat Oncol Biol Phys 2008; 70 (3): 678–684.CrossRefGoogle ScholarPubMed
6.Rothschild, S, Studer, G, Seifert, Bet al. PET/CT staging followed by intensity-modulated radiotherapy (IMRT) improves treatment outcome of locally advanced pharyngeal carcinoma: a matched-pair comparison. Radiother Oncol 2007; 2 (22): 1–10.Google ScholarPubMed
7.Ha, P K, Hdeib, A, Goldernberg, Det al. The role of positron emission tomography and computed tomography fusion in the management of early-stage and advanced-stage primary head and neck squamous cell carcinoma. Arch Otolaryngol Head Neck Surg 2006; 132: 12–16.CrossRefGoogle ScholarPubMed
8.Dietl, B, Marienhagen, J, Kuhnel, Tet al. FDG-PET in radiotherapy treatment planning of advanced head and neck cancer—a prospective clinical analysis. Auris Nasus Larynx 2006; 33 (3): 303–309.CrossRefGoogle ScholarPubMed
9.Kajitani, C, Asakawa, I, Uto, Fet al. Efficacy of FDG-PET for defining gross tumor volume of head and neck cancer. J Radiat Res 2013; 54: 671–678.CrossRefGoogle ScholarPubMed
10.Steenbakkers, R J H M, Duppen, J C, Fitton, Iet al. Observer variation in target volume delineation of lung cancer related to radiation oncologist-computer interaction: a ‘Big Brother’ evaluation. Radiother Oncol 2005; 77: 182–190.CrossRefGoogle ScholarPubMed
11.Dos Santos, D T, Lima, E N P, Chojniak, Ret al. Topographic metabolic map of head and neck squamous cell carcinoma using 18F-FDG PET and CT image fusion. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 100: 619–625.CrossRefGoogle ScholarPubMed
12.Yaremko, B, Riauka, T, Robinson, Det al. Thresholding in PET images of static and moving targets. Phys Med Biol 2005; 50: 5969–5982.CrossRefGoogle ScholarPubMed
13.Hwang, A B, Bachrach, S L, Yom, S Set al. Can positron emission tomography (PET) or PET/computed tomography (CT) acquired in a nontreatment position be accurately registered to a head-and-neck radiotherapy planning CT? Int J Radiat Oncol Biol Phys 2009; 73 (2): 578–584.CrossRefGoogle Scholar
14.Soto, D E, Kessler, M L, Piert, Met al. Correlation between pretreatment FDG-PET biological target volume and anatomical location of failure after radiation therapy for head and neck cancers. Radiother Oncol 2008; 89 (1): 13–18.CrossRefGoogle ScholarPubMed
15.Robertson, M L, Gleich, L L, Barrett, W Let al. Base-of-tongue cancer: survival, function, and quality of life after external-beam irradiation and brachytherapy. Laryngoscope 2001; 111 (8): 1362–1365.CrossRefGoogle ScholarPubMed
16.Beadle, B M, Liao, K P, Elting, L Set al. Improved survival using intensity-modulated radition therapy in head and neck cancers. Cancer 2014; 120: 702–710.CrossRefGoogle Scholar
17.Ang, K, Pajak, T, Wheeler, Ret al. A phase III trial to test accelerated (AFX) versus standard (SFX) fractionation in combination with concurrent cisplatin for head and neck carcinomas (RTOG 0129): report of efficacy and toxicity. Int J Rad Onc Biol Phys 2010; 77 (1): 1–2.CrossRefGoogle Scholar
18.Huncharek, M, Kupelnick, B.Combined chemoradiation versus radiation therapy alone in locally advanced nasopharyngeal carcinoma: results of a meta-analysis of 1,528 patients from six randomized trials. Am J Clin Oncol 2002; 25 (3): 219–223.CrossRefGoogle Scholar
19.Wang, K, Heron, D E, Clump, D Aet al. Target delineation in stereotactic body radiation therapy for recurrent head and neck cancer: a retrospective analysis of the impact of margins and automated PET-CT segmentation. Radiother Oncol 2013; 106: 90–95.CrossRefGoogle ScholarPubMed
20.Thorwarth, D, Eschmann, S M, Scheiderbauer, Jet al. Kinetic analysis of dynamic 18F-fluoromisonidazole PET correlates with radiation treatment outcome in head-and-neck cancer. BMC Cancer 2005; 5: 152.CrossRefGoogle ScholarPubMed
21.Postema, E J, McEwan, A J, Riauka, T Aet al. Initial results of hypoxia imaging using 1-alpha-D-(5-deoxy-5-[18F]-fluoroarabinofuranyosyl)-2-nitroimidazole (18F-FAZA). Eur J Nucl Med Mol Imaging 2009; 36 (10): 1565–1573.CrossRefGoogle Scholar
22.Troost, E G, Bussink, J, Hoffman, A Let al. 18F-FLT PET/CT for early response monitoring and dose escalation in oropharyngeal tumors. J Nucl Med 2010; 51 (6): 866–874.CrossRefGoogle ScholarPubMed
23.Arens, A I J, Troost, E G C, Hoeben, BAWet al. Semiautomatic methods for segmentation of the proliferative tumour volume on sequential FLT PET/CT images in head and neck carcinomas and their relation to clinical outcome. Eur J Nucl Med Mol Imaging 2014; 41 (5): 915–924.CrossRefGoogle ScholarPubMed
24.Hoeben, B A W, Bussink, J, Troost, E G Cet al. Molecular PET imaging for biology-guided adaptice radiotherapy of head and neck cancer. Acta Oncologica 2013; 52: 1257–1271.CrossRefGoogle ScholarPubMed