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01-03-2015 | Original article

Hypoxia imaging with [18F]-FMISO-PET for guided dose escalation with intensity-modulated radiotherapy in head-and-neck cancers

Authors: B. Henriques de Figueiredo, M.D., Ph.D., C. Zacharatou, Ph.D., S. Galland-Girodet, M.D., J. Benech, Ph.D., H. De Clermont-Gallerande, M.D., F. Lamare, Ph.D., M. Hatt, Ph.D., L. Digue, M.D., E. De Mones del Pujol, M.D., P. Fernandez, M.D., Ph.D.

Published in: Strahlentherapie und Onkologie | Issue 3/2015

Abstract

Background and purpose

Positron emission tomography (PET) with [¹⁸F]-fluoromisonidazole ([¹⁸F]-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 [¹⁸F]-FMISO-PET for head-and-neck cancers (HNC).

Patients and methods

Ten patients with inoperable stages III–IV HNC underwent [¹⁸F]-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 % respectively.

Conclusion

A dose escalation up to 79.8 Gy guided by [¹⁸F]-FMISO-PET with VMAT seems feasible with improvement of TCP and without excessive increase of NTCP for parotids.

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Title: Hypoxia imaging with [18F]-FMISO-PET for guided dose escalation with intensity-modulated radiotherapy in head-and-neck cancers
Authors: B. Henriques de Figueiredo, M.D., Ph.D.
C. Zacharatou, Ph.D.
S. Galland-Girodet, M.D.
J. Benech, Ph.D.
H. De Clermont-Gallerande, M.D.
F. Lamare, Ph.D.
M. Hatt, Ph.D.
L. Digue, M.D.
E. De Mones del Pujol, M.D.
P. Fernandez, M.D., Ph.D.
Publication date: 01-03-2015
Publisher: Springer Berlin Heidelberg
Published in: Strahlentherapie und Onkologie / Issue 3/2015
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-014-0752-8

At a glance: The STEP trials

Springer Medicine

Hypoxia imaging with [18F]-FMISO-PET for guided dose escalation with intensity-modulated radiotherapy in head-and-neck cancers

Abstract

Background and purpose

Patients and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background and purpose

Patients and methods

Results

Conclusion

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