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Early 18F-FDG-PET Response During Radiation Therapy for HPV-Related Oropharyngeal Cancer May Predict Disease Recurrence.
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 articleSubject
HumansPapillomavirus 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
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https://hdl.handle.net/10161/24159Published Version (Please cite this version)
10.1016/j.ijrobp.2020.08.029Publication 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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Show full item recordScholars@Duke
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 care for lo
Yvonne Marie Mowery
Butler Harris Assistant Professor in Radiation Oncology
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.
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)
Qiuwen Wu
Professor of Radiation Oncology
My research interests include intensity-modulated radiation therapy (IMRT), volumetric-modulated
arc therapy (VMAT), Dynamic Electron Arc Radiotherapy (DEAR), and image-guided radiation
therapy (IGRT). For IMRT, my work includes 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 a
dynamic multi-leaf collimator (DMLC). For VMAT, I am interested
David Sung-Hyun Yoo
Assistant Professor of Radiation Oncology
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