Three-phase adaptive dose-painting-by-numbers for head-and-neck cancer: initial results of the phase I clinical trial

18F-Fdg-PET-guided Planning and Re-Planning (Adaptive) Radiotherapy in Head and Neck Cancer: Current State of Art

“…Currently, only one center (68,69) reported on clinical experience on dose painting in 18 F-FDG PET-guided ART.…”

“…In fact anatomic and functional changes occur during the entire RT duration and it is important to take into account also the onset of actinic inflammation creating noisier imaging difficult to assess. Also, the group of Ghent University Hospital used two replanning for each radiation treatment in their two clinical trials (68,69). In fact, a single replanning is not considered sufficient to detect all target variations occurring during the therapy.…”

The promise of multiparametric imaging in oncology: how do we move forward?

“…The radiation dose can be intensified or deescalated for different tumour regions according to the expected treatment sensitivity derived from imaging data to improve local tumour control without increasing toxicity. Several clinical trials are looking into this approach, and treatment personalization can be performed at different levels; ranging from the subvolume level to the very fine voxel level [24][25][26]. In analogy to the pattern-of-relapse approach, dose painting requires detailed analysis to find dose-response relationships between functional imaging, underlying pathology and outcome to design appropriate clinical trials.…”

Validation of functional imaging as a biomarker for radiation treatment response

“…32 Following Phase I, studies demonstrated the feasibility of adaptive 18 F-FDG-PET-voxel intensity-based intensity modulated radiotherapy (IMRT) using dose painting by numbers in patients with head and neck cancer as well the feasibility of using deformable image co-registration of a three-phase adaptive 18 F-FDG-PET-guided dose painting by numbers tool. 74,75 In a recent Phase I clinical trial, a dose escalation in 18 F-FDG regions and dose painting by numbers approach (i.e. dose prescription to voxels as a function of signal intensity of the corresponding voxel in a biological image) was used for adaptation of radiation treatment volumes based on 18 F-FDG-PET/CT-detected biological and anatomical changes at the end of the second week of treatment.…”