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WE‐D‐AUD C‐02: Hypoxia‐guided Intensity‐Modulated Radiation Therapy for Head and Neck Cancer
Author(s) -
Lee N,
Humm J
Publication year - 2008
Publication title -
medical physics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.473
H-Index - 180
eISSN - 2473-4209
pISSN - 0094-2405
DOI - 10.1118/1.2962743
Subject(s) - medicine , radiation therapy , nuclear medicine , head and neck cancer , radioresistance , tumor hypoxia , dosimetry , positron emission tomography , radiology , radiation treatment planning , head and neck , image registration , hypoxia (environmental) , surgery , chemistry , organic chemistry , oxygen , artificial intelligence , computer science , image (mathematics)
Purpose: Hypoxia renders tumor cells radioresistant; limits locoregional control(LRC) from radiation therapy. IMRT allows targeting of the gross tumor volume(GTV) and can potentially deliver a higher dose to hypoxic subvolumes(GTV h ) while sparing normal tissues. This study examines the feasibility of18F ‐ FMISO PET/CT‐guided IMRT with the goal to maximally escalate the dose to radioresistant hypoxic zones in a cohort of HNCA patients. Materials and Methods:18F ‐ FMISO was administered IV for PET imaging. CT simulation, FDG PET/CT, and18F ‐ FMISO PET/CT scans were co‐registered using the same immobilization. Tumor boundaries were defined by clinical examination and available imaging including FDG PET/CT. Regions of elevated18F ‐ FMISO uptake within the FDG PET/CT GTV were targeted for IMRT boost. Additional targets/normal structures were contoured/transferred to treatment planning to generate18F ‐ FMISO PET/CT‐guided IMRT plans. Results: The heterogeneous distribution of18F ‐ FMISO within the GTV demonstrated variable levels of hypoxia within the tumor. Plans directed at performing18F ‐ FMISO PET/CT‐guided IMRT for 10 HNCA patients achieved 84 Gy to GTV h , 70Gy to GTV, without exceeding normal tissue tolerance. We further attempted to deliver 105 Gy to GTV h for two patients and were successful in one with normal tissue sparing. Conclusion: It was feasible to dose escalate GTV h to 84 Gy in all 10 patients and in one patient to 105 Gy without exceeding normal tissue tolerance. This information provided important data for subsequent hypoxia‐guided IMRT trials with the goal of further improving LRC in HNCA.