Patterns-of-failure guided biological target volume definition for head and neck cancer patients: FDG-PET and dosimetric analysis of dose escalation candidate subregions. Radiother Oncol 2017 Aug;124(2):248-255
Date
08/05/2017Pubmed ID
28774596Pubmed Central ID
PMC5600500DOI
10.1016/j.radonc.2017.07.017Scopus ID
2-s2.0-85026498392 (requires institutional sign-in at Scopus site) 31 CitationsAbstract
BACKGROUND: To identify the radio-resistant subvolumes in pretreatment FDG-PET by mapping the spatial location of the origin of tumor recurrence after IMRT for head-and-neck squamous cell cancer to the pretreatment FDG-PET/CT.
METHODS: Patients with local/regional recurrence after IMRT with available FDG-PET/CT and post-failure CT were included. For each patient, both pre-therapy PET/CT and recurrence CT were co-registered with the planning CT (pCT). A 4-mm radius was added to the centroid of mapped recurrence growth target volumes (rGTV's) to create recurrence nidus-volumes (NVs). The overlap between boost-tumor-volumes (BTV) representing different SUV thresholds/margins combinations and NVs was measured.
RESULTS: Forty-seven patients were eligible. Forty-two (89.4%) had type A central high dose failure. Twenty-six (48%) of type A rGTVs were at the primary site and 28 (52%) were at the nodal site. The mean dose of type A rGTVs was 71Gy. BTV consisting of 50% of the maximum SUV plus 10mm margin was the best subvolume for dose boosting due to high coverage of primary site NVs (92.3%), low average relative volume to CTV1 (41%), and least average percent voxels outside CTV1 (19%).
CONCLUSIONS: The majority of loco-regional recurrences originate in the regions of central-high-dose. When correlated with pretreatment FDG-PET, the majority of recurrences originated in an area that would be covered by additional 10mm margin on the volume of 50% of the maximum FDG uptake.
Author List
Mohamed ASR, Cardenas CE, Garden AS, Awan MJ, Rock CD, Westergaard SA, Brandon Gunn G, Belal AM, El-Gowily AG, Lai SY, Rosenthal DI, Fuller CD, Aristophanous MAuthor
Musaddiq J. Awan MD Associate Professor in the Radiation Oncology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Aged, 80 and over
Dose-Response Relationship, Radiation
Female
Fluorodeoxyglucose F18
Head and Neck Neoplasms
Humans
Male
Middle Aged
Neoplasm Recurrence, Local
Positron Emission Tomography Computed Tomography
Positron-Emission Tomography
Radiopharmaceuticals
Radiotherapy Planning, Computer-Assisted
Tomography, X-Ray Computed
Treatment Failure
Tumor Burden