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. 2012 Apr 19:4:12.
doi: 10.1186/1758-3284-4-12.

A retrospective, deformable registration analysis of the impact of PET-CT planning on patterns of failure in stereotactic body radiation therapy for recurrent head and neck cancer

Kyle Wang  1 , Dwight E Heron, John C Flickinger, Jean-Claude M Rwigema, Robert L Ferris, Gregory J Kubicek, James P Ohr, Annette E Quinn, Cihat Ozhasoglu, Barton F Branstetter
Affiliations

A retrospective, deformable registration analysis of the impact of PET-CT planning on patterns of failure in stereotactic body radiation therapy for recurrent head and neck cancer

Kyle Wang et al. Head Neck Oncol. .

Expression of concern in

  • Comment: Head and Neck Oncology.
    BioMed Central. BioMed Central. BMC Med. 2014 Feb 5;12:24. doi: 10.1186/1741-7015-12-24. BMC Med. 2014. PMID: 24499430 Free PMC article. Review.

Abstract

Background: Stereotactic body radiation therapy (SBRT) has seen increasing use as a salvage strategy for selected patients with recurrent, previously-irradiated squamous cell carcinoma of the head and neck (rSCCHN). PET-CT may be advantageous for tumor delineation and evaluation of treatment failures in SBRT. We analyzed the patterns of failure following SBRT for rSCCHN and assessed the impact of PET-CT treatment planning on these patterns of failure.

Methods: We retrospectively reviewed 96 patients with rSCCHN treated with SBRT. Seven patients (7%) were treated after surgical resection of rSCCHN and 89 patients (93%) were treated definitively. PET-CT treatment planning was used for 45 patients whereas non-PET-CT planning was used for 51 patients. Categories of failure were assigned by comparing recurrences on post-treatment scans to the planning target volume (PTV) from planning scans using the deformable registration function of VelocityAI™. Failures were defined: In-field (>75% inside PTV), Overlap (20-75% inside PTV), Marginal (<20% inside PTV but closest edge within 1cm of PTV), or Regional/Distant (more than 1cm from PTV).

Results: Median follow-up was 7.4 months (range, 2.6-52 months). Of 96 patients, 47 (49%) developed post-SBRT failure. Failure distribution was: In-field-12.3%, Overlap-24.6%, Marginal-36.8%, Regional/Distant-26.3%. There was a significant improvement in overall failure-free survival (log rank p = 0.037) and combined Overlap/Marginal failure-free survival (log rank p = 0.037) for those receiving PET-CT planning vs. non-PET-CT planning in the overall cohort (n = 96). Analysis of the definitive SBRT subgroup (n = 89) increased the significance of these findings (overall failure: p = 0.008, Overlap/Marginal failure: p = 0.009). There were no significant differences in age, gender, time from prior radiation, dose, use of cetuximab with SBRT, tumor differentiation, and tumor volume between the PET-CT and non-PET-CT groups.

Conclusions: Most failures after SBRT treatment for rSCCHN were near misses, i.e. Overlap/Marginal failures (61.4%), suggesting an opportunity to improve outcomes with more sensitive imaging. PET-CT treatment planning showed the lowest rate of overall and near miss failures and is beneficial for SBRT treatment planning.

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Figures

Figure 1
Figure 1
Examples of categories of failure. Pre-treatment scans (left) are fused to post-treatment scans demonstrating recurrence (right). Recurrent tumors are contoured, compared to deformed PTVs (red), and categorized. A–In-field (blue) and regional (yellow) failure. B–Overlap failures (blue, yellow). C–Marginal failure (blue).
Figure 2
Figure 2
Distribution of failure outcomes. 47 out of 96 (49%) patients receiving SBRT for rSCCHN had treatment failures in one or more categories. Distribution of failure events was In-field–7 (12·3%), Overlap–14 (24.6%), Marginal–21 (36.8%), Regional/Distant–15 (26.3%).
Figure 3
Figure 3
PET-CT planning vs. non-PET-CT planning. A,B–Overall failure-free survival (A) and Overlap/Marginal failure-free survival (B) for PET-CT planning (green) vs. non-PET-CT planning (blue) in the overall cohort (n = 96). C,D–Overall failure-free survival (C) and Overlap/Marginal failure-free survival (D) for PET-CT planning (green) vs. non-PET-CT planning (blue) in the definitive SBRT cohort (n = 89).
See this image and copyright information in PMC

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