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Early 18F-FDG-PET Response During Radiation Therapy for HPV-Related Oropharyngeal Cancer May Predict Disease Recurrence.

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Date
2020-11
Authors
Mowery, Yvonne M
Vergalasova, Irina
Rushing, Christel N
Choudhury, Kingshuk Roy
Niedzwiecki, Donna
Wu, Qiuwen
Yoo, David S
Das, Shiva
Wong, Terence Z
Brizel, David M
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Abstract
<h4>Purpose</h4>Early indication of treatment outcome may guide therapeutic de-escalation strategies in patients with human papillomavirus (HPV)-related oropharyngeal cancer (OPC). This study investigated the relationships between tumor volume and 18F-fluorodeoxyglucose positron emission tomography (PET) parameters before and during definitive radiation therapy with treatment outcomes.<h4>Methods and materials</h4>Patients undergoing definitive (chemo)radiation for HPV-related/p16-positive OPC were prospectively enrolled on an institutional review board-approved study. 18F-fluorodeoxyglucose PET/computed tomography scans were performed at simulation and after 2 weeks at a dose of ∼20 Gy. Tumor volume and standardized uptake value (SUV) characteristics were measured. SUV was normalized to blood pool uptake. Tumor volume and PET parameters associated with recurrence were identified through recursive partitioning (RPART). Recurrence-free survival (RFS) and overall survival (OS) curves between RPART-identified cohorts were estimated using the Kaplan-Meier method, and Cox models were used to estimate the hazard ratios (HRs).<h4>Results</h4>From 2012 to 2016, 62 patients with HPV-related OPC were enrolled. Median follow-up was 4.4 years. RPART identified patients with intratreatment SUVmax (normalized to blood pool SUVmean) <6.7 or SUV<sub>max</sub> (normalized to blood pool SUVmean) ≥6.7 with intratreatment SUV40% ≥2.75 as less likely to recur. For identified subgroups, results of Cox models showed unadjusted HRs for RFS and OS (more likely to recur vs less likely) of 7.33 (90% confidence interval [CI], 2.97-18.12) and 6.09 (90% CI, 2.22-16.71), respectively, and adjusted HRs of 6.57 (90% CI, 2.53-17.05) and 5.61 (90% CI, 1.90-16.54) for RFS and OS, respectively.<h4>Conclusions</h4>PET parameters after 2 weeks of definitive radiation therapy for HPV-related OPC are associated with RFS and OS, thus potentially informing an adaptive treatment approach.
Type
Journal article
Subject
Humans
Papillomavirus Infections
Oropharyngeal Neoplasms
Neoplasm Recurrence, Local
Cisplatin
Fluorodeoxyglucose F18
Antineoplastic Agents
Radiopharmaceuticals
Treatment Outcome
Tumor Burden
Analysis of Variance
Proportional Hazards Models
Prospective Studies
Middle Aged
Female
Male
Human papillomavirus 16
Kaplan-Meier Estimate
Positron Emission Tomography Computed Tomography
Docetaxel
Permalink
https://hdl.handle.net/10161/24159
Published Version (Please cite this version)
10.1016/j.ijrobp.2020.08.029
Publication Info
Mowery, Yvonne M; Vergalasova, Irina; Rushing, Christel N; Choudhury, Kingshuk Roy; Niedzwiecki, Donna; Wu, Qiuwen; ... Brizel, David M (2020). Early 18F-FDG-PET Response During Radiation Therapy for HPV-Related Oropharyngeal Cancer May Predict Disease Recurrence. International journal of radiation oncology, biology, physics, 108(4). pp. 969-976. 10.1016/j.ijrobp.2020.08.029. Retrieved from https://hdl.handle.net/10161/24159.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

Brizel

David Manfield Brizel

Leonard Prosnitz Distinguished Professor of Radiation Oncology
Head and neck cancer has constituted both my principal clinical and research foci since I came to Duke University in 1987. I designed and led a single institution phase 3 randomized clinical trial, initiated in 1989, which was one of the first in the world to demonstrate that radiotherapy and concurrent chemotherapy (CRT) was more efficacious than radiotherapy alone (RT) for treating locally advanced head and neck cancer. CRT has since been established as the non-surgical standard of ca
Mowery

Yvonne Marie Mowery

Butler Harris Assistant Professor in Radiation Oncology
Niedzwiecki

Donna Niedzwiecki

Professor of Biostatistics & Bioinformatics
Primary interests include clinical trials design and the design and analysis of biomarker and imaging studies especially in the areas of GI cancer, lymphoma, melanoma, transplant and cancer immunotherapy.
Wong

Terence Z. Wong

Professor of Radiology
1. Anatomic/functional oncologic Imaging: SPECT/CT, PET/CT, novel PET radiotracers 2. Radiotheranostics, Radionuclide therapy of cancer, Radiation Therapy Planning 3. Imaging biomarkers for guiding treatment strategies 4. Multicenter clinical trial development (NCI National Clinical Trials Network)
Wu

Qiuwen Wu

Professor of Radiation Oncology
My research interests include intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), electron arc therapy (EAT) and image-guided radiation therapy (IGRT). For IMRT, my work include the development of the research platform, fast and accurate dose calculations, optimization based on physical and biological objectives such as generalized equivalent uniform dose (gEUD), and delivery with dynamic multi-leaf collimator (DMLC). For VMAT, I am interested in the optim
Yoo

David Sung-Hyun Yoo

Assistant Professor of Radiation Oncology
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