An analysis of positron emission tomography maximum standard uptake value among patients with head and neck cancer receiving photon and proton radiation Journal Article


Authors: Youssef, I.; Mohamed, N.; Kallini, D.; Zakeri, K.; Lin, H.; Han, D.; Qi, H.; Nosov, A.; Riaz, N.; Chen, L.; Yu, Y.; Dunn, L. A.; Sherman, E. J.; Wray, R.; Schöder, H.; Lee, N. Y.
Article Title: An analysis of positron emission tomography maximum standard uptake value among patients with head and neck cancer receiving photon and proton radiation
Abstract: Purpose: One main advantage of proton therapy versus photon therapy is its precise radiation delivery to targets without exit dose, resulting in lower dose to surrounding healthy tissues. This is critical, given the proximity of head and neck tumors to normal structures. However, proton planning requires careful consideration of factors, including air-tissue interface, anatomic uncertainties, surgical artifacts, weight fluctuations, rapid tumor response, and daily variations in setup and anatomy, as these heterogeneities can lead to inaccuracies in targeting and creating unwarranted hotspots to a greater extent than photon radiation. In addition, the elevated relative biological effectiveness at the Bragg peak's distal end can also increase hot spots within and outside the target area. Methods and Materials: The purpose of this study was to evaluate for a difference in positron emission tomography (PET) standard uptake value (SUV) after definitive treatment, between intensity modulated proton therapy (IMPT) and intensity modulated photon therapy (IMRT). In addition, we compared the biologic dose between PET areas of high and low uptake within the clinical target volume–primary of patients treated with IMPT. This work is assuming that the greater SUV may potentially result in greater toxicities. For the purposes of this short communication, we are strictly focusing on the SUV and do not have correlation with toxicity outcomes. To accomplish this, we compared the 3- and 6-month posttreatment fluorodeoxyglucose PET scans for 100 matched patients with oropharyngeal cancer treated definitively without surgery using either IMPT (n = 50) or IMRT (n = 50). Results: Our study found a significant difference in biologic dose between the high- and low-uptake regions on 3-month posttreatment scans of IMPT. However, this difference did not translate to a significant difference in PET uptake in the clinical target volume–primary at 3 and 6 months’ follow-up between patients who received IMPT versus IMRT. Conclusions: Studies have proposed that proton's greater relative biological effectiveness at the Bragg peak could lead to tissue inflammation. Our study did not corroborate these findings. This study's conclusion underscores the need for further investigations with ultimate correlation with clinical toxicity outcomes. © 2024 Elsevier Inc.
Keywords: adult; controlled study; aged; middle aged; major clinical study; intensity modulated radiation therapy; cancer patient; comparative study; positron emission tomography; follow up; antineoplastic agent; radiotherapy dosage; radiotherapy; inflammation; cohort analysis; patient monitoring; diagnostic imaging; head and neck cancer; tumors; head and neck neoplasms; radiotherapy, intensity-modulated; fluorodeoxyglucose f 18; fluorodeoxyglucose f18; positron-emission tomography; surgery; oropharynx cancer; radiotherapy planning, computer-assisted; relative biological effectiveness; photon therapy; photons; drug therapy; toxicity; relative biologic effectiveness; photon; diseases; head and neck tumor; positrons; head-and-neck cancer; standardized uptake value; post treatment; clinical target volume; adverse event; standard uptake values; proton therapy; hotspots; procedures; clinical target volumes; proton radiations; maximum standardized uptake value; humans; human; male; female; article; radiotherapy planning system; proton beams; positron emission tomography-computed tomography; proton beam therapy; photon radiation; intensity modulated proton therapies; bragg peaks; body weight fluctuation
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 120
Issue: 5
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2024-12-01
Start Page: 1326
End Page: 1331
Language: English
DOI: 10.1016/j.ijrobp.2024.03.011
PUBMED: 38499254
PROVIDER: scopus
PMCID: PMC12147173
DOI/URL:
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF. Corresponding MSK author is Nancy Y. Lee -- Source: Scopus
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
  1. Eric J Sherman
    341 Sherman
  2. Nadeem Riaz
    417 Riaz
  3. Nancy Y. Lee
    876 Lee
  4. Heiko Schoder
    544 Schoder
  5. Lara   Dunn
    141 Dunn
  6. Yao Yu
    114 Yu
  7. Linda Chang Chen
    69 Chen
  8. Kaveh Zakeri
    82 Zakeri
  9. Nader Mohamed
    16 Mohamed
  10. Anton Nosov
    9 Nosov
  11. Rick Wray
    18 Wray
  12. Irini Yacoub
    14 Yacoub