Maximum tolerated dose in a phase I trial on adaptive dose painting by numbers for head and neck cancer

被引:101
作者
Madani, Indira [1 ]
Duprez, Frederic [1 ]
Boterberg, Tom [1 ]
Van de Wiele, Christophe [2 ]
Bonte, Katrien [3 ]
Deron, Philippe [3 ]
De Gersem, Werner [1 ]
Coghe, Marc [1 ]
De Neve, Wilfried [1 ]
机构
[1] Ghent Univ Hosp, Dept Radiotherapy, B-9000 Ghent, Belgium
[2] Ghent Univ Hosp, Dept Nucl Med, B-9000 Ghent, Belgium
[3] Ghent Univ Hosp, Dept Head & Neck Surg, B-9000 Ghent, Belgium
关键词
Dose-limiting toxicity; Dose-painting-by-numbers; Adaptive IMRT; Head and neck cancer; (18)F-FDG-PET; INTENSITY-MODULATED RADIOTHERAPY; POSITRON-EMISSION-TOMOGRAPHY; RADIATION-THERAPY; TARGET VOLUME; IMRT; DELINEATION; EXPERIENCE; CARCINOMA; BRACHYTHERAPY; PROPOSAL;
D O I
10.1016/j.radonc.2011.06.020
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: To determine the maximum tolerated dose (MTD) in a phase I trial on adaptive dose-painting-by-numbers (DPBN) for non-metastatic head and neck cancer. Materials and methods: Adaptive intensity-modulated radiotherapy was based on voxel intensity of pre-treatment and per-treatment [(18)F]fluoro-2-deoxy-D-glucose positron emission tomography ((18)F-FDG-PET)/CT scans. Dose was escalated to a median total dose of 80.9 Gy in the high-dose clinical target volume (dose level I) and 85.9 Gy in the gross tumor volume (dose level II). The MTD would be reached, if >= 33% of patients developed any grade >= 4 toxicity (DLT) up to 3 months follow-up. Results: Between February 2007 and August 2009, seven patients at dose level I and 14 at dose level II were treated. All patients completed treatment without interruption. At a median follow-up for surviving patients of 38 (dose level I) and 22 months (dose level II) there was no grade >= 4 toxicity during treatment and follow-up but six cases of mucosal ulcers at latency of 4-10 months, of which five (36%) were observed at dose level II. Mucosal ulcers healed spontaneously in four patients. Conclusions: Considering late mucosal ulcers as DLT, the MTD of a median dose of 80.9 Gy has been reached in our trial. (C) 2011 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 101 (2011) 351-355
引用
收藏
页码:351 / 355
页数:5
相关论文
共 27 条
[1]  
[Anonymous], 1995, INT J RAD ONCOLOGY B, V31, P1049, DOI DOI 10.1016/0360-3016(95)90159-0
[2]   Quantification of volumetric and geometric changes occurring during fractionated radiotherapy for head-and-neck cancer using an integrated CT/linear accelerator system [J].
Barker, JL ;
Garden, AS ;
Ang, KK ;
O'Daniel, JC ;
Wang, H ;
Court, LE ;
Morrison, WH ;
Rosenthal, DI ;
Chao, KSC ;
Tucker, SL ;
Mohan, R ;
Dong, L .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2004, 59 (04) :960-970
[3]   INTENSITY-MODULATED RADIOTHERAPY IN THE TREATMENT OF OROPHARYNGEAL CANCER: CLINICAL OUTCOMES AND PATTERNS OF FAILURE [J].
Daly, Megan E. ;
Le, Quynh-Thu ;
Maxim, Peter G. ;
Loo, Billy W., Jr. ;
Kaplan, Michael J. ;
Fischbein, Nancy J. ;
Pinto, Harlan ;
Chang, Daniel T. .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2010, 76 (05) :1339-1346
[4]   Intensity-modulated radiation therapy for the treatment of oropharyngeal carcinoma: The Memorial Sloan-Kettering Cancer Center experience [J].
de Arruda, FF ;
Puri, DR ;
Zhung, J ;
Narayana, A ;
Wolden, S ;
Hunt, M ;
Stambuk, H ;
Pfister, D ;
Kraus, D ;
Shaha, A ;
Shah, J ;
Lee, NY .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2006, 64 (02) :363-373
[5]   Leaf position optimization for step-and-shoot IMRT [J].
De Gersem, W ;
Claus, F ;
De Wagter, C ;
Van Duyse, B ;
De Neve, W .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2001, 51 (05) :1371-1388
[6]   An anatomy-based beam segmentation tool for intensity-modulated radiation therapy and its application to head-and-neck cancer [J].
De Gersem, W ;
Claus, F ;
De Wagter, C ;
De Neve, W .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2001, 51 (03) :849-859
[7]   Reduction of target dose inhomogeneity in IMRT treatment planning using biologic objective functions - In response [J].
De Neve, W ;
De Gersem, W ;
De Meerleer, G ;
Claus, F ;
De Wagter, C .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2001, 49 (05) :1519-1520
[8]   Dose Painting in Radiotherapy for Head and Neck Squamous Cell Carcinoma: Value of Repeated Functional Imaging with 18F-FDG PET, 18F-Fluoromisonidazole PET, Diffusion-Weighted MRI, and Dynamic Contrast-Enhanced MRI [J].
Dirix, Piet ;
Vandecaveye, Vincent ;
De Keyzer, Frederik ;
Stroobants, Sigrid ;
Hermans, Robert ;
Nuyts, Sandra .
JOURNAL OF NUCLEAR MEDICINE, 2009, 50 (07) :1020-1027
[9]  
Duprez F, 2010, INT J RAD ONCOL 0717
[10]   Intensity-Modulated Chemoradiotherapy Aiming to Reduce Dysphagia in Patients With Oropharyngeal Cancer: Clinical and Functional Results [J].
Feng, Felix Y. ;
Kim, Hyungjin M. ;
Lyden, Teresa H. ;
Haxer, Marc J. ;
Worden, Francis P. ;
Feng, Mary ;
Moyer, Jeffrey S. ;
Prince, Mark E. ;
Carey, Thomas E. ;
Wolf, Gregory T. ;
Bradford, Carol R. ;
Chepeha, Douglas B. ;
Eisbruch, Avraham .
JOURNAL OF CLINICAL ONCOLOGY, 2010, 28 (16) :2732-2738