Welz Stefan, Mönnich David, Pfannenberg Christina, Nikolaou Konstantin, Reimold Mathias, La Fougère Christian, Reischl Gerald, Mauz Paul-Stefan, Paulsen Frank, Alber Markus, Belka Claus, Zips Daniel, Thorwarth Daniela
Department of Radiation Oncology, University of Tübingen, Germany.
Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Germany.
Radiother Oncol. 2017 Sep;124(3):526-532. doi: 10.1016/j.radonc.2017.04.004. Epub 2017 Apr 20.
To prospectively assess the prognostic value of tumour hypoxia determined by dynamic [F]Fluoromisonidazole (dynFMISO) PET/CT, and to evaluate both feasibility and toxicity in patients with locally advanced squamous cell carcinomas of the head and neck (LASCCHN) treated with dynFMISO image-guided dose escalation (DE) using dose-painting by contours.
We present a planned interim analysis of a randomized phase II trial. N=25 patients with LASCCHN received baseline dynFMISO PET/CT to derive hypoxic volumes (HV). Patients with tumour hypoxia were randomized into standard radiochemotherapy (stdRT) (70Gy/35 fractions) or DE (77Gy/35 fractions) to the HV. Patients with non-hypoxic tumours were treated with stdRT. Loco-regional control (LRC) in hypoxic patients randomized to stdRT was compared to non-hypoxic patients. Feasibility and toxicity were analysed for patients in the DE arm and compared to stdRT.
With a mean follow-up of 27months, LRC in hypoxic patients receiving stdRT (n=10) was significantly worse compared to the non-hypoxic group (n=5) (2y-LRC 44.4% versus 100%, p=0.048). The respective LRC for the DE group (n=10) was 70.0%. Treatment compliance as well as acute and late toxicity did not show significant differences between the DE and the standard dose arms.
Tumour hypoxia determined by baseline dynFMISO PET/CT is associated with a high risk of local failure in patients with LASCCHN. First data suggest that DE to HV is feasible without excess toxicity.
前瞻性评估动态[F]氟米索硝唑（dynFMISO）PET/CT测定的肿瘤缺氧的预后价值，并评估采用轮廓勾画剂量引导剂量递增（DE）治疗局部晚期头颈部鳞状细胞癌（LASCCHN）患者的可行性及毒性。
我们展示了一项随机II期试验的计划中期分析。25例LASCCHN患者接受基线dynFMISO PET/CT以得出缺氧体积（HV）。肿瘤缺氧的患者被随机分为标准放化疗（stdRT）（70Gy/35次分割）或对HV进行DE（77Gy/35次分割）。无缺氧肿瘤的患者接受stdRT治疗。将随机接受stdRT的缺氧患者的局部区域控制（LRC）与无缺氧患者进行比较。分析DE组患者的可行性和毒性，并与stdRT组进行比较。
平均随访27个月，接受stdRT的缺氧患者（n = 10）的LRC明显差于无缺氧组（n = 5）（2年LRC为44.4%对100%，p = 0.048）。DE组（n = 10）的相应LRC为70.0%。DE组与标准剂量组在治疗依从性以及急性和晚期毒性方面未显示出显著差异。
基线dynFMISO PET/CT测定的肿瘤缺氧与LASCCHN患者的局部失败高风险相关。初步数据表明，对HV进行DE是可行的，且无过度毒性。
