Dose escalation to hypoxic subvolumes in head and neck cancer: A randomized phase II study using dynamic [18F]FMISO PET/CT

Welz, Stefan; Paulsen, Frank; Pfannenberg, Christina; Reimold, Matthias; Reischl, Gerald; Nikolaou, Konstantin; Fougère, Christian la; Alber, M.; Belka, Claus; Zips, Daniel; Thorwarth, Daniela

doi:10.1016/j.radonc.2022.03.021

Cited by 35 publications

(20 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This study confirmed the prognostic value of hypoxia PET and dose escalation, improving the 5-year LRC by 25% (P = 0.15). Unfortunately, the study also had slow accrual and closed early, possibly owing to the complexity of the design 123 .…”

Section: Review Articlementioning

confidence: 99%

Predicting tumour radiosensitivity to deliver precision radiotherapy

2022

View full text Add to dashboard Cite

Owing to advances in radiotherapy, the physical properties of radiation can be optimized to enable individualized treatment; however, optimization is rarely based on biological properties and, therefore, treatments are generally planned with the assumption that all tumours respond similarly to radiation. Radiation affects multiple cellular pathways, including DNA damage, hypoxia, proliferation, stem cell phenotype and immune response. In this Review, we summarize the effect of these pathways on tumour responses to radiotherapy and the current state of research on genomic classifiers designed to exploit these variations to inform treatment decisions. We also discuss whether advances in genomics have generated evidence that could be practice changing and whether advances in genomics are now ready to be used

show abstract

Section: Review Articlementioning

confidence: 99%

Predicting tumour radiosensitivity to deliver precision radiotherapy

2022

View full text Add to dashboard Cite

show abstract

“…This could be done using functional imaging that shows hypoxic subvolumes of tumors resulting in a “biological target volume” (BTV). To counteract radioresistance associated with hypoxic tumors, radiation oncologists can escalate the dose to these hypoxic regions of cancer to achieve better tumor control without compromising normal tissue tolerance [ 49 , 50 ].…”

Section: Hypoxia In Head and Neck Cancersmentioning

confidence: 99%

“…So far, there is only one randomized phase II study (NCT02352792) recently published by Welz et al on this issue with 53 locally advanced HNC patients enrolled; out of them, 39 (74%) had hypoxic tumors [ 50 ]. Patients were randomized irrespective of hypoxia into standard treatment (70 Gy/35 fractions) or dose-escalated arm (77 Gy/35 fractions, by 2.2 Gy per fraction as simultaneous boost).…”

Section: Hypoxia In Head and Neck Cancersmentioning

confidence: 99%

FMISO-Based Adaptive Radiotherapy in Head and Neck Cancer

Doležel

Slavík

Blazek

et al. 2022

JPM

View full text Add to dashboard Cite

Concurrent chemoradiotherapy represents one of the most used strategies in the curative treatment of patients with head and neck (HNC) cancer. Locoregional failure is the predominant recurrence pattern. Tumor hypoxia belongs to the main cause of treatment failure. Positron emission tomography (PET) using hypoxia radiotracers has been studied extensively and has proven its feasibility and reproducibility to detect tumor hypoxia. A number of studies confirmed that the uptake of FMISO in the recurrent region is significantly higher than that in the non-recurrent region. The escalation of dose to hypoxic tumors may improve outcomes. The technical feasibility of optimizing radiotherapeutic plans has been well documented. To define the hypoxic tumour volume, there are two main approaches: dose painting by contour (DPBC) or by number (DPBN) based on PET images. Despite amazing technological advances, precision in target coverage, and surrounding tissue sparring, radiation oncology is still not considered a targeted treatment if the “one dose fits all” approach is used. Using FMISO and other hypoxia tracers may be an important step for individualizing radiation treatment and together with future radiomic principles and a possible genome-based adjusting dose, will move radiation oncology into the precise and personalized era.

show abstract

“…When using both FDG-PET and (18)F-FMISO imaging, a combined pattern can predict for risk of recurrence after SBRT ( 171 ). In head and neck cancer (18), F-FMISO PET/CT has been used to identify tumor areas with hypoxia requiring dose escalation ( 172 ).…”

Section: Metabolic Imaging and Treatment Modulationmentioning

confidence: 99%

Metabolic targeting, immunotherapy and radiation in locally advanced non-small cell lung cancer: Where do we go from here?

Dhawan

Pifer²,

Sandulache³

et al. 2022

Front. Oncol.

View full text Add to dashboard Cite

In the US, there are ~250,000 new lung cancer diagnoses and ~130,000 deaths per year, and worldwide there are an estimated 1.6 million deaths per year from this deadly disease. Lung cancer is the most common cause of cancer death worldwide, and it accounts for roughly a quarter of all cancer deaths in the US. Non-small cell lung cancer (NSCLC) represents 80-85% of these cases. Due to an enormous tobacco cessation effort, NSCLC rates in the US are decreasing, and the implementation of lung cancer screening guidelines and other programs have resulted in a higher percentage of patients presenting with potentially curable locoregional disease, instead of distant disease. Exciting developments in molecular targeted therapy and immunotherapy have resulted in dramatic improvement in patients’ survival, in combination with new surgical, pathological, radiographical, and radiation techniques. Concurrent platinum-based doublet chemoradiation therapy followed by immunotherapy has set the benchmark for survival in these patients. However, despite these advances, ~50% of patients diagnosed with locally advanced NSCLC (LA-NSCLC) survive long-term. In patients with local and/or locoregional disease, chemoradiation is a critical component of curative therapy. However, there remains a significant clinical gap in improving the efficacy of this combined therapy, and the development of non-overlapping treatment approaches to improve treatment outcomes is needed. One potential promising avenue of research is targeting cancer metabolism. In this review, we will initially provide a brief general overview of tumor metabolism as it relates to therapeutic targeting. We will then focus on the intersection of metabolism on both oxidative stress and anti-tumor immunity. This will be followed by discussion of both tumor- and patient-specific opportunities for metabolic targeting in NSCLC. We will then conclude with a discussion of additional agents currently in development that may be advantageous to combine with chemo-immuno-radiation in NSCLC.

show abstract

Dose escalation to hypoxic subvolumes in head and neck cancer: A randomized phase II study using dynamic [18F]FMISO PET/CT

Cited by 35 publications

References 46 publications

Predicting tumour radiosensitivity to deliver precision radiotherapy

Predicting tumour radiosensitivity to deliver precision radiotherapy

FMISO-Based Adaptive Radiotherapy in Head and Neck Cancer

Metabolic targeting, immunotherapy and radiation in locally advanced non-small cell lung cancer: Where do we go from here?

Contact Info

Product

Resources

About