Strategy of using intratreatment hypoxia imaging to selectively and safely guide radiation dose de-escalation concurrent with chemotherapy for locoregionally advanced human papillomavirus-related oropharyngeal carcinoma Journal Article
| Authors: | Lee, N.; Schoder, H.; Beattie, B.; Lanning, R.; Riaz, N.; McBride, S.; Katabi, N.; Li, D.; Yarusi, B.; Chan, S.; Mitrani, L.; Zhang, Z.; Pfister, D. G.; Sherman, E.; Baxi, S.; Boyle, J.; Morris, L. G. T.; Ganly, I.; Wong, R.; Humm, J. |
| Article Title: | Strategy of using intratreatment hypoxia imaging to selectively and safely guide radiation dose de-escalation concurrent with chemotherapy for locoregionally advanced human papillomavirus-related oropharyngeal carcinoma |
| Abstract: | Purpose To report a small substudy of an ongoing large, multi-arm study using functional imaging to assess pre-/intratreatment hypoxia for all head and neck cancer, in which we hypothesized that pre- and early-treatment hypoxia assessment using functional positron emission tomography (PET) imaging may help select which human papillomavirus (HPV)-positive (HPV+) oropharyngeal cancer (OPC) patients can safely receive radiation de-escalation without jeopardizing treatment outcomes. Methods and Materials Patients with HPV+ oropharyngeal carcinoma were enrolled on an institutional review board–approved prospective study of which de-escalation based on imaging response was done for node(s) only. Pretreatment 18F-fluorodeoxyglucose and dynamic 18F-FMISO (fluoromisonidazole) positron emission tomography (PET) scans were performed. For patients with pretreatment hypoxia on18F-FMISO PET (defined as a >1.2 tumor to muscle standard uptake value ratio), a repeat scan was done 1 week after chemoradiation. Patients without pretreatment hypoxia or with resolution of hypoxia on repeat scan received a 10-Gy dose reduction to metastatic lymph node(s). The 2-year local, regional, distant metastasis–free, and overall survival rates were estimated using the Kaplan-Meier product-limit method. A subset of patients had biopsy of a hypoxic node done under image guidance. Results Thirty-three HPV+ OPC patients were enrolled in this pilot study. One hundred percent showed pretreatment hypoxia (at primary site and/or node[s]), and among these, 48% resolved (at primary site and/or node[s]); 30% met criteria and received 10-Gy reduction to the lymph node(s). At the median follow-up of 32 months (range, 21-61 months), the 2-year locoregional control rate was 100%. One patient failed distantly with persistence of hypoxia on 18F-FMISO PET. The 2-year distant metastasis–free rate was 97%. The 2-year OS rate was 100%. Hypoxia on imaging was confirmed pathologically. Conclusions Hypoxia is present in HPV+ tumors but resolves within 1 week of treatment in 48% of cases either at the primary site and/or lymph node(s). Our 100% locoregional control rate suggests that intratreatment functional imaging used to selectively de-escalate node(s) to 60 Gy was confirmed safe using our stringent imaging criteria. Intratreatment functional imaging warrants further study to determine its ultimate role in de-escalation treatment strategies. © 2016 Elsevier Inc. |
| Keywords: | chemotherapy; positron emission tomography; radiotherapy; pathology; tumors; body fluids; patient treatment; diseases; positron emission tomography (pet); positrons; overall survival rates; standard uptake values; institutional review boards; locoregional control rate; 18-f-fluorodeoxyglucose; metastatic lymph nodes; oropharyngeal carcinomata |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 96 |
| Issue: | 1 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2016-09-01 |
| Start Page: | 9 |
| End Page: | 17 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2016.04.027 |
| PROVIDER: | scopus |
| PMCID: | PMC5035649 |
| PUBMED: | 27511842 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 2 November 2016 -- Source: Scopus |
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