Hypoxia imaging with [18F]-FMISO-PET for guided dose escalation with intensity-modulated radiotherapy in head-and-neck cancers.
Strahlenther Onkol. 2014-09-23; 191(3): 217-224
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1. Strahlenther Onkol. 2015 Mar;191(3):217-24. doi: 10.1007/s00066-014-0752-8. Epub
2014 Sep 23.
Hypoxia imaging with [18F]-FMISO-PET for guided dose escalation with
intensity-modulated radiotherapy in head-and-neck cancers.
Henriques de Figueiredo B(1), Zacharatou C, Galland-Girodet S, Benech J, De
Clermont-Gallerande H, Lamare F, Hatt M, Digue L, De Mones del Pujol E, Fernandez
(1)Department of Radiotherapy, Institut Bergonié, 229, cours de l’Argonne, 33076,
BORDEAUX Cedex, France, .
BACKGROUND AND PURPOSE: Positron emission tomography (PET) with
[(18)F]-fluoromisonidazole ([(18)F]-FMISO) provides a non-invasive assessment of
hypoxia. The aim of this study is to assess the feasibility of a dose escalation
with volumetric modulated arc therapy (VMAT) guided by [(18)F]-FMISO-PET for
head-and-neck cancers (HNC).
PATIENTS AND METHODS: Ten patients with inoperable stages III-IV HNC underwent
[(18)F]-FMISO-PET before radiotherapy. Hypoxic target volumes (HTV) were
segmented automatically by using the fuzzy locally adaptive Bayesian method.
Retrospectively, two VMAT plans were generated delivering 70 Gy to the gross
tumour volume (GTV) defined on computed tomography simulation or 79.8 Gy to the
HTV. A dosimetric comparison was performed, based on calculations of tumour
control probability (TCP), normal tissue complication probability (NTCP) for the
parotid glands and uncomplicated tumour control probability (UTCP).
RESULTS: The mean hypoxic fraction, defined as the ratio between the HTV and the
GTV, was 0.18. The mean average dose for both parotids was 22.7 Gy and 25.5 Gy
without and with dose escalation respectively. FMISO-guided dose escalation led
to a mean increase of TCP, NTCP for both parotids and UTCP by 18.1, 4.6 and 8%
CONCLUSION: A dose escalation up to 79.8 Gy guided by [(18)F]-FMISO-PET with VMAT
seems feasible with improvement of TCP and without excessive increase of NTCP for
PMID: 25245468 [Indexed for MEDLINE]