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

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Mowery, Yvonne M

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Vergalasova, Irina

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Rushing, Christel N

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Choudhury, Kingshuk Roy

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Niedzwiecki, Donna

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Wu, Qiuwen

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Yoo, David S

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Das, Shiva

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Wong, Terence Z

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Brizel, David M

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2022-01-01T15:04:30Z

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2022-01-01T15:04:30Z

dc.date.issued

2020-11

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2022-01-01T15:04:30Z

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Purpose

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.

Methods and materials

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).

Results

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 SUVmax (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.

Conclusions

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.
dc.identifier

S0360-3016(20)34118-3

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0360-3016

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1879-355X

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https://hdl.handle.net/10161/24159

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eng

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Elsevier BV

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International journal of radiation oncology, biology, physics

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10.1016/j.ijrobp.2020.08.029

dc.subject

Humans

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Papillomavirus Infections

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Oropharyngeal Neoplasms

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Neoplasm Recurrence, Local

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Cisplatin

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Fluorodeoxyglucose F18

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Antineoplastic Agents

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Radiopharmaceuticals

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Treatment Outcome

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Tumor Burden

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Analysis of Variance

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Proportional Hazards Models

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Prospective Studies

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Middle Aged

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Female

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Male

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Human papillomavirus 16

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Kaplan-Meier Estimate

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Positron Emission Tomography Computed Tomography

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Docetaxel

dc.title

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

dc.type

Journal article

duke.contributor.orcid

Mowery, Yvonne M|0000-0002-9839-2414

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Niedzwiecki, Donna|0000-0002-3566-0450

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Wu, Qiuwen|0000-0003-0748-7280

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Wong, Terence Z|0000-0002-1435-3187|0000-0002-3830-1779

pubs.begin-page

969

pubs.end-page

976

pubs.issue

4

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School of Medicine

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Duke Cancer Institute

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Radiology, Nuclear Medicine

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Medicine, Medical Oncology

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Duke

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Institutes and Centers

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Radiology

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Clinical Science Departments

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Medicine

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Faculty

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Radiation Oncology

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Head and Neck Surgery & Communication Sciences

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Biostatistics & Bioinformatics

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Basic Science Departments

pubs.publication-status

Published

pubs.volume

108

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