PET/CT-guided dose-painting versus CT-based intensity modulated radiation therapy in locoregional advanced nasopharyngeal carcinoma

被引：35
作者：
Liu, Feng [1 ,2 ,3 ]
Xi, Xu-ping [1 ,2 ,3 ]
Wang, Hui [1 ,2 ,3 ]
Han, Ya-qian [1 ,2 ,3 ]
Xiao, Feng [1 ,2 ]
Hu, Ying [1 ,2 ]
He, Qian [1 ,2 ]
Zhang, Lin [1 ,2 ]
Xiao, Qin [1 ,2 ,3 ]
Liu, Lin [1 ,2 ]
Luo, Le [1 ,2 ]
Li, Yun [1 ,2 ]
Mo, Yi [1 ,2 ]
Ma, Hong-zhi [1 ,2 ]
机构：
[1] Cent South Univ, Hunan Canc Hosp, Dept Radiat Oncol, Changsha, Hunan, Peoples R China
[2] Cent South Univ, Affiliated Canc Hosp, Xiangya Sch Med, Changsha, Hunan, Peoples R China
[3] Cent South Univ, Key Lab Translat Radiat Oncol, Hunan Prov Dept Radiat Oncol, Hunan Canc Hosp, Changsha, Hunan, Peoples R China
来源：
RADIATION ONCOLOGY | 2017年 / 12卷
关键词：
Nasopharyngeal carcinoma; FDG-PET/CT; Dose painting; Intensity-Modulated Radiation Therapy; Toxicity; PHASE-I TRIAL; CONCURRENT CHEMORADIOTHERAPY; PROGNOSTIC VALUE; FDG-PET; HEAD; RADIOTHERAPY; CHEMOTHERAPY; NUMBERS; TUMOR; BRACHYTHERAPY;
D O I：
10.1186/s13014-016-0739-y
中图分类号：
R73 [肿瘤学];
学科分类号：
100214 ;
摘要：
Background: The effect of F-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT)-guided dose-painting intensity-modulated radiation therapy (IMRT) in locoregionally advanced nasopharyngeal carcinoma (NPC) is unclear. This study aimed to assess the efficacy and toxicity of such combination. Methods: From 2012 to 2014, 213 patients with stage III-IVB NPC received chemoradiotherapy by PET/CT-guided DP-IMRT (group A, n = 101) or CT-based IMRT (group B, n = 112). In group A, subvolume GTVnx-(PET) (gross tumor volume of nasopharynx in PET images) was defined within GTVnx (gross tumor volume of nasopharynx) as the SUV50% max isocontour; the dose to GTVnx-(PET) was escalated to DT 75.2 Gy/32 and 77.55 Gy/33 Fx, respectively, for patients with T1-2 and T3-4 disease, respectively. In group B, PGTVnx was irradiated at DT 70.4-72.6 Gy/32-33 Fx in 2.2 Gy per fraction. Results: Complete response rates were 99.0% (100/101) and 92.9% (104/112) in groups A and B, respectively (P = 0.037). Compared with CT-based IMRT, FDG-PET/CT guided DP-IMRT significantly improved 3-year local failure-free survival (LFFS, 98.8% vs. 91.3%; P = 0.032), locoregional failure-free survival (LRFFS, 97.2 vs. 91.2%; P = 0.049), distant metastasis-free survival (DMFS, 92.9% vs. 87.4%; P = 0.041), disease free survival (DFS, 87.9% vs. 82.4%; P = 0.02), and overall survival (OS, 91.8% vs. 82.6%; P = 0.049). No statistically significant differences in acute and late toxic effects were observed. Multivariate analysis showed that dose painting (PET/CT-guided DP-IMRT vs CT-based IMRT without DP) was a significant independent prognostic factor for LFFS and DFS. Conclusion: FDG-PET/CT guided DP-IMRT plus chemotherapy is associated with a considerable survival benefit, without increasing toxicity in patients with locoregional advanced NPC. Further randomized trials are needed to fully assess the role of PET/CT-guided DP-IMRT.
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页数：10
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