1. 18F-FDG-PET/CT-based treatment planning for definitive (chemo)radiotherapy in patients with head and neck squamous cell carcinoma improves regional control and survival.
- Author
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van den Bosch, Sven, Doornaert, Patricia A.H., Dijkema, Tim, Zwijnenburg, Ellen M., Verhoef, Lia C.G., Hoeben, Bianca A.W., Kasperts, Nicolien, Smid, Ernst J., Terhaard, Chris H.J., and Kaanders, Johannes H.A.M.
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SQUAMOUS cell carcinoma , *RADIOTHERAPY , *DEFINITIONS - Abstract
• FDG-PET/CT-based nodal target volume definition improves regional control and survival. • No isolated recurrences in the electively treated neck occurred with FDG-PET/CT-based nodal target volume definition. • FDG-PET/CT-based nodal target volume definition causes target volume transformation. • FDG-PET/CT can guide gradient dose prescription with de-escalation of the elective dose. Multimodality imaging including 18F-FDG-PET has improved the detection threshold of nodal metastases in head and neck squamous cell carcinoma (HNSCC). The aim of this retrospective analysis is to investigate the impact of FDG-PET/CT-based nodal target volume definition (FDG-PET/CT-based NTV) on radiotherapy outcomes, compared to conventional CT-based nodal target volume definition (CT-based NTV). Six-hundred-thirty-three patients treated for HNSCC with definitive (chemo)radiotherapy using IMRT/VMAT techniques between 2008 and 2017 were analyzed. FDG-PET/CT-based NTV was performed in 46% of the patients. The median follow-up was 31 months. Diagnostic imaging depicting the regional recurrence was co-registered with the initial CT-scan to reconstruct the exact site of the recurrence. Multivariate Cox regression analysis was performed to identify variables associated with radiotherapy outcome. FDG-PET/CT-based NTV improved control of disease in the CTV elective-nodal (HR: 0.33, p = 0.026), overall regional control (HR: 0.62, p = 0.027) and overall survival (HR: 0.71, p = 0.033) compared to CT-based NTV. The risk for recurrence in the CTV elective-nodal was increased in case of synchronous local recurrence of the primary tumor (HR: 12.4, p < 0.001). FDG-PET/CT-based NTV significantly improved control of disease in the CTV elective-nodal , overall regional control and overall survival compared to CT-based NTV. A significant proportion of CTV elective-nodal recurrences are potentially new nodal manifestations from a synchronous local recurrent primary tumor. These results support the concept of target volume transformation and give an indication of the potential of FDG-PET to guide gradual radiotherapy dose de-escalation in elective neck treatment in HNSCC. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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