OC-0375: Hypoxia dose-escalation with chemoradiation in head and neck cancer: planned interim analysis of a randomized study

Welz, Stephan; Pfannenberg, C.; Reimold, Mathias; Reischl, G; Mauz, Paul-Stefan; Zips, Daniel; Alber, M.; Belka, C.; Thorwarth, Daniela

doi:10.1016/s0167-8140(15)30480-1

Cited by 3 publications

(5 citation statements)

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“…Patients randomized into the experimental arm are treated with a 10% dose escalation, that is, 77 Gy, to a hypoxic volume defined on the basis of dynamic 18 F-fluoromisonidazole PET data. The planned interim analysis for the first 20 patients recruited into this study showed that dose escalation on this order of magnitude is well tolerated (41). Furthermore, results from this study have confirmed a prognostic model relating individual tumor control probability to the dynamic 18 F-fluoromisonidazole PET data established in an earlier study (44).…”

Section: Pet For Radiation Treatment Adaptation and Normal-tissue Chasupporting

confidence: 69%

“…Because of the above findings from exploratory imaging studies, a few centers have started phase I or II studies to investigate the potential and limitations of individualized radiotherapy strategies adapted on the basis of functional imaging information acquired before or during radiotherapy (31,(39)(40)(41). To date, biologic adaptation strategies consist mainly of escalating the dose to functionally abnormal or radioresistant subvolumes inside the gross tumor volume (GTV), even though results from preclinical studies on this topic are still eagerly awaited.…”

Section: Pet For Radiation Treatment Adaptation and Normal-tissue Chamentioning

confidence: 99%

“…A German single-institution randomized phase II study is investigating the clinical feasibility of hypoxia dose escalation in HNSCC (41). Patients randomized into the experimental arm are treated with a 10% dose escalation, that is, 77 Gy, to a hypoxic volume defined on the basis of dynamic 18 F-fluoromisonidazole PET data.…”

Section: Pet For Radiation Treatment Adaptation and Normal-tissue Chamentioning

confidence: 99%

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Imaging-Based Treatment Adaptation in Radiation Oncology

2015

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Learning Objectives: On successful completion of this activity, participants should be able to (1) understand the clinical implications of tumor characterization using different PET tracers before and during radiotherapy or chemoradiotherapy; (2) discuss the role of other functional imaging modalities (CT and MRI) in current oncology practice; and (3) introduce additional applications of PET imaging, such as in high-energy proton-beam therapy.

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Section: Pet For Radiation Treatment Adaptation and Normal-tissue Chasupporting

confidence: 69%

Section: Pet For Radiation Treatment Adaptation and Normal-tissue Chamentioning

confidence: 99%

Section: Pet For Radiation Treatment Adaptation and Normal-tissue Chamentioning

confidence: 99%

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Imaging-Based Treatment Adaptation in Radiation Oncology

2015

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“…Summarizing these data, they prompt the scientific community to integrate hypoxia PET imaging into radiation treatment planning for hypoxia-directed dose escalation strategies. At present, a German mono-institutional randomized phase II clinical trial investigates the clinical feasibility of FMISO-PET-based dose escalation in HNSCC (Welz et al 2014). Patients in the standard arm undergo a conventional total dose of 70 Gy (chemo)radiotherapy, whereas in the experimental arm, patients receive 10 % dose escalation, i.e.…”

Section: Clinical Studiesmentioning

confidence: 99%

FMISO as a Biomarker for Clinical Radiation Oncology

Zschaeck

Steinbach

Troost

2016

Molecular Radio-Oncology

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Tumour hypoxia is a well-known negative prognostic marker in almost all solid tumours. [18F]Fluoromisonidazole (FMISO)-positron emission tomography (PET) is a non-invasive method to detect tumour hypoxia. Compared to other methods of hypoxia assessment it possesses some considerable advantages: It is non-invasive, it delivers spatial information on the hypoxia distribution within the entire tumour volume, and it can be repeated during the course of radio(chemo)therapy. This chapter briefly describes different methods of hypoxia evaluation and focuses on hypoxia PET imaging, with the most commonly used tracer being FMISO. The preclinical rationale and clinical studies to use FMISO-PET for patient stratification in radiation therapy are discussed as well as possible agents or radiation-dose modifications to overcome hypoxia.

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“…Dose escalation to interim BTVs may spare dose excesses to healthy tissue and tumor regions with good treatment response that may otherwise be targeted when using solely prior-to-treatment (baseline) PET images to de ne the BTV. While baseline PET imaging has been used for dose escalation with promising results (20), there is, to the extent of our knowledge, a lack of literature on response-adaptive dose escalation based on interim PET for proton therapy. Exploring this gap can contribute to more precise and effective proton therapy, our in silico analysis thus presents the rst results of incorporating interim PET data into the proton therapy work ow.…”

Section: Introductionmentioning

confidence: 99%

Interim 18F-FDG-PET based response-adaptive dose escalation of proton therapy for head and neck cancer: a treatment planning feasibility study

Garrido-Hernandez,

Henjum,

Winter

et al. 2023

Preprint

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Background Image-driven dose escalation to tumor subvolumes has been proposed to improve treatment outcome in head and neck cancer (HNC). We used 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) acquired at baseline and two-three weeks into treatment (interim) to identify biologic target volumes (BTV). We assessed the feasibility of interim dose escalation to the BTV with proton therapy by simulating the effects to organs at risk (OARs). Methods We used the semiautomated just-enough-interaction (JEI) method to semi-automatically identify BTVs from 18F-FDG-PET images from nine HNC patients. Between baseline and interim FDG-PET all patients received photon radiotherapy. BTV was defined by assuming that lasting standardized uptake value (SUV) at interim reflects tumor radioresistance. Using Eclipse (Varian Medical Systems), we simulated the effects of a 10% (6.8 Gy(RBE1.1)) dose escalation to the BTV with protons and compared results with proton plans without dose escalation. Results At interim 18F-FDG-PET, radiotherapy resulted in reduced SUV compared to baseline. However, there was a spatial overlap between high-SUV regions at baseline and interim that allowed definition of the BTV. Proton therapy planning demonstrated that dose escalation to the BTV was feasible while the increases in median and max dose to OARs remained below 2.0 Gy(RBE1.1) and 1.0 Gy(RBE1.1), respectively. Conclusion Our in silico analysis demonstrated the potential for response-adaptive dose escalation to the BTV with proton therapy based on interim 18F-FDG-PET. This approach may give more efficient treatment to HNC with radioresistant tumor subvolumes without increasing normal tissue toxicity. Further studies in larger cohorts are required to determine the full potential for interim 18F-FDG-PET-guided dose escalation of proton therapy in HNC.

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OC-0375: Hypoxia dose-escalation with chemoradiation in head and neck cancer: planned interim analysis of a randomized study

Cited by 3 publications

References 0 publications

Imaging-Based Treatment Adaptation in Radiation Oncology

Imaging-Based Treatment Adaptation in Radiation Oncology

FMISO as a Biomarker for Clinical Radiation Oncology

Interim 18F-FDG-PET based response-adaptive dose escalation of proton therapy for head and neck cancer: a treatment planning feasibility study

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