| Jianshe Wang,Tianyou Tang,Jing Xu,Andrew Z. Wang,Liang Li,Junnian Zheng,Longzhen Zhang. Clinical role of 18F-FDG PET/CT-based simultaneous modulated accelerated radiotherapy treatment planning for locally advanced nasopharyngeal carcinoma. Oncol Transl Med, 2015, 1: 264-270. |
| Clinical role of 18F-FDG PET/CT-based simultaneous modulated accelerated radiotherapy treatment planning for locally advanced nasopharyngeal carcinoma |
| Received:February 22, 2015 Revised:November 18, 2015 |
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| KeyWord:nasopharyngeal carcinoma (NPC); simultaneous modulated accelerated radiotherapy; intensity-modulated radiotherapy; positron emission tomography/computed tomography (PET/CT); ?uorine-18-?uorodeoxyglucose (18F-FDG) |
| Author Name | Affiliation | E-mail | | Jianshe Wang | Affiliated Hospital of Xuzhou Medical College,Cancer Institute of Xuzhou Medical College | wjsemail18@163.com | | Tianyou Tang | Affiliated Hospital of Xuzhou Medical College | tty912@163.com | | Jing Xu | Functional Lab of Xuzhou Medical College,Jiangsu,China | xujing197818@163.com | | Andrew Z. Wang | University of North Carolina-Chapel Hill, Chapel Hill, NC, USA | andrew_wang@med.unc.edu | | Liang Li | Affiliated Hospital of Xuzhou Medical College
Cancer Institute of Xuzhou Medical College,Jiangsu,China
Functional Lab of Xuzhou Medical College,Jiangsu,China
Department of Radiation Oncology,University of North Carolina-Chapel Hill,Chapel Hill,NC,USA | 46585129@qq.com | | Junnian Zheng | Xuzhou Medical College | zhengjunnian@sina.com | | Longzhen Zhang | Affiliated Hospital of Xuzhou Medical College,Cancer Institute of Xuzhou Medical College | jsxzzlz@126.com |
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| Abstract: |
| Objective?The aim of this study was to compare the long-term local control, overall survival, and late toxicities of positron emission tomography/computed tomography (PET/CT)-guided dose escalation radiotherapy versus conventional radiotherapy in the concurrent chemoradiotherapy treatment of locally advanced nasopharyngeal carcinoma (NPC).
Methods?A total of 48 patients with stage III–IVa NPC were recruited and randomly administered PET/CT-guided dose escalation chemoradiotherapy (group A) or conventional chemoradiotherapy (group B). The dose-escalation radiotherapy was performed using the simultaneous modulated accelerated radiotherapy technique at prescribed doses of 77 gray (Gy) in 32 fractions (f) to the gross target volume (GTV): planning target volume (PTV) 1 received 64 Gy/32 f, while PTV2 received 54.4 Gy/32 f. Patients in group B received uniform-dose intensity-modulated radiotherapy, PTV1 received 70 Gy/35 f and PTV2 received 58 Gy/29 f. Concurrent chemotherapy consisted of cisplatin [20 mg/m2 intravenous (IV) on days 1–4] and docetaxel (75 mg/m2 IV on days 1 and 8) administered during treatment weeks 1 and 4. All patients received 2–4 cycles of adjuvant chemotherapy of the same dose and drug regimen.
Results?The use of ?uorine-18-?uorodeoxyglucose (18F-FDG) PET/CT significantly reduced the treatment volume delineation of the GTV in 83.3% (20/24) of patients. The 5-year local recurrence-free survival rates of the two groups were 100% and 79.2%, respectively (P = 0.019). The 5-year disease free survival (DFS) rates were 95.8% and 75.0%, respectively (P = 0.018). The 5-year local progression-free survival and DFS rates were significantly different. The 5-year overall survival (OS) rates were 95.8% and 79.2%, respectively. Differences in OS improvement were insignificant (P = 0.079). Late toxicities were similar in the two groups. The most common late toxicities of the two arms were grade 1–2 skin dystrophy, xerostomia, subcutaneous fibrosis, and hearing loss. There were no cases of grade 4 late toxicity.
Conclusion?The use of 18F-FDG PET/CT-guided dose escalation radiotherapy is well tolerated and can reduce local recurrence rates for patients with locally advanced NPC compared to conventional chemoradiotherapy.
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