Early Toxicity and Patient Reported Outcomes From a Phase 2 Trial of FDG-PET Response-Based De-Escalated Definitive Radiotherapy for p16+ Oropharynx Cancer

Allen, Saul; Rosen, Benjamin; Aryal, Madhava; Cao, Yang; Schipper, M.; Casper, Keith; Chinn, Sedona; Malloy, Kelly M.; Prince, Mark; Rosko, Andrew J.; Shuman, Andrew G.; Spector, Matthew E.; Stucken, Chaz L.; Swiecicki, Paul; Worden, F.; Brenner, J. Chad; Elliott, D.A.; Schonewolf, Caitlin; Shah, Jennifer

doi:10.1016/j.ijrobp.2021.12.014

Cited by 5 publications

(4 citation statements)

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“…Eligibility for radiotherapy deintensification requires at least a 50% reduction in composite MTV at 2 weeks, relative to baseline. Planned interim analysis reported by Allen et al 46 confirmed feasibility and demonstrated a reduction of objective toxicity measures, such as weight loss and Penetration Aspiration Score, in the deintensified cohort, without present evidence of inferior tumor-control outcomes. In another trial utilizing midtreatment PET for identifying patients eligible for radiation deintensification (NCT00606294), patients with no pretreatment or complete resolution of hypoxia, measured using F-MISO after 1 week of CRT, received de-escalated radiotherapy (60 Gy/30 fxs in initial cohort, 35,47 then 30 Gy/15 fxs for the expansion cohort 48 ).…”

Section: Observational Studiesmentioning

confidence: 75%

The Utility of Interim Positron Emission Tomography Imaging to Inform Adaptive Radiotherapy for Head and Neck Squamous Cell Carcinoma

2023

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In this article, as part of this special issue on biomarkers of early response, we review the current evidence to support the use of positron emission tomography (PET) imaging during chemoradiation therapy to inform biologically adaptive radiotherapy for head and neck squamous cell carcinoma. We review literature covering this topic spanning nearly 3 decades, including the use of various radiotracers and discoveries of novel predictive PET biomarkers. Through understanding how observational trials have informed current interventional clinical trials, we hope that this review will encourage researchers and clinicians to incorporate PET response criteria in new trial designs to advance biologically optimized radiotherapy.

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Section: Observational Studiesmentioning

confidence: 75%

The Utility of Interim Positron Emission Tomography Imaging to Inform Adaptive Radiotherapy for Head and Neck Squamous Cell Carcinoma

2023

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“…The results of several studies are still awaited (NCT03224000, NCT03972072, NCT04242459, and NCT03935672). Mid‐treatment FDG/PET imaging can also be used to select patients for de‐escalated radiotherapy in good prognosis HPV+ OPC, as shown by Allen et al 126 . Finally, facilitation of ART is crucial for the utilization of proton therapy in clinical practice for HNC patients.…”

Section: Future Perspectivesmentioning

confidence: 98%

“…125 The results of several studies are still awaited (NCT03224000, NCT03972072, NCT04242459, and NCT03935672). Mid-treatment FDG/PET imaging can also be used to select patients for de-escalated radiotherapy in good prognosis HPV+ OPC, as shown by Allen et al 126 Finally, facilitation of ART is crucial for the utilization of proton therapy in clinical practice for HNC patients. Proton therapy has been proven a promising treatment for patients with HNC, since it offers the ability to deliver high doses to the TV while minimizing the dose to the adjacent OAR.…”

Section: Adaptation Of Target Volumesmentioning

confidence: 99%

Adaptive radiotherapy for head and neck cancer: Pitfalls and possibilities from the radiation oncologist's point of view

Nuyts,

Bollen,

Eisbruch

et al. 2024

Cancer Medicine

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BackgroundPatients with head and neck cancer (HNC) may experience substantial anatomical changes during the course of radiotherapy treatment. The implementation of adaptive radiotherapy (ART) proves effective in managing the consequent impact on the planned dose distribution.MethodsThis narrative literature review comprehensively discusses the diverse strategies of ART in HNC and the documented dosimetric and clinical advantages associated with these approaches, while also addressing the current challenges for integration of ART into clinical practice.Results and ConclusionAlthough based on mainly non‐randomized and retrospective trials, there is accumulating evidence that ART has the potential to reduce toxicity and improve quality of life and tumor control in HNC patients treated with RT. However, several questions remain regarding accurate patient selection, the ideal frequency and timing of replanning, and the appropriate way for image registration and dose calculation. Well‐designed randomized prospective trials, with a predetermined protocol for both image registration and dose summation, are urgently needed to further investigate the dosimetric and clinical benefits of ART.

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“…How to best tailor definitive therapy is unknown, and likely traditional clinical factors (e.g., smoking status) are insufficient. In fact, early results of several de-escalation strategies suggest that deintensified treatment in patients with a smoking history results in favorable outcomes 19–21 . Circulating tumor DNA kinetics during treatment or at the end of treatment may be a means to determine which patients have a favorable response to therapy and which are at high risk for treatment failure and persistent disease.…”

Section: During Treatment and At Treatment Completionmentioning

confidence: 99%

The Current Role of Human Papillomavirus Circulating Tumor DNA in Oropharynx Cancer

Regan

2023

Cancer J

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Human papillomavirus infection is currently implicated in the majority of oropharyngeal squamous cell carcinoma cases diagnosed in the United States. Circulating tumor DNA (ctDNA) has emerged as a potential biomarker for human papillomavirus–related oropharyngeal squamous cell carcinoma and has the opportunity to improve the diagnosis, treatment, and surveillance of patients with this disease. Changes in ctDNA levels during and after primary therapy may be related to disease response, which can possibly have implications for treatment intensification or de-escalation strategies. Further, ctDNA seems to be sensitive and specific for disease recurrence and may improve upon current methods for assessing both treatment response and failure. In this review, we examine the relevant literature on the use of ctDNA for oropharyngeal cancer treatment and surveillance and discuss current limitations and future directions for this promising biomarker.

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Early Toxicity and Patient Reported Outcomes From a Phase 2 Trial of FDG-PET Response-Based De-Escalated Definitive Radiotherapy for p16+ Oropharynx Cancer

Cited by 5 publications

References 0 publications

The Utility of Interim Positron Emission Tomography Imaging to Inform Adaptive Radiotherapy for Head and Neck Squamous Cell Carcinoma

The Utility of Interim Positron Emission Tomography Imaging to Inform Adaptive Radiotherapy for Head and Neck Squamous Cell Carcinoma

Adaptive radiotherapy for head and neck cancer: Pitfalls and possibilities from the radiation oncologist's point of view

The Current Role of Human Papillomavirus Circulating Tumor DNA in Oropharynx Cancer

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