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. 2017 Jan 13;12(1):15.
doi: 10.1186/s13014-016-0739-y.

PET/CT-guided dose-painting versus CT-based intensity modulated radiation therapy in locoregional advanced nasopharyngeal carcinoma

Feng Liu  1   2 , Xu-Ping Xi  3   4 , Hui Wang  5   6 , Ya-Qian Han  1   2 , Feng Xiao  1 , Ying Hu  1 , Qian He  1 , Lin Zhang  1 , Qin Xiao  1   2 , Lin Liu  1 , Le Luo  1 , Yun Li  1 , Yi Mo  1 , Hong-Zhi Ma  1
Affiliations

PET/CT-guided dose-painting versus CT-based intensity modulated radiation therapy in locoregional advanced nasopharyngeal carcinoma

Feng Liu et al. Radiat Oncol. .

Abstract

Background: The effect of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT)-guided dose-painting intensity-modulated radiation therapy (IMRT) in locoregionally advanced nasopharyngeal carcinoma (NPC) is unclear. This study aimed to assess the efficacy and toxicity of such combination.

Methods: From 2012 to 2014, 213 patients with stage III-IVB NPC received chemoradiotherapy by PET/CT-guided DP-IMRT (group A, n = 101) or CT-based IMRT (group B, n = 112). In group A, subvolume GTVnx-PET (gross tumor volume of nasopharynx in PET images) was defined within GTVnx (gross tumor volume of nasopharynx) as the SUV50%max isocontour; the dose to GTVnx-PET was escalated to DT 75.2 Gy/32 and 77.55 Gy/33 Fx, respectively, for patients with T1-2 and T3-4 disease, respectively. In group B, PGTVnx was irradiated at DT 70.4-72.6 Gy/32-33 Fx in 2.2 Gy per fraction.

Results: Complete response rates were 99.0% (100/101) and 92.9% (104/112) in groups A and B, respectively (P = 0.037). Compared with CT-based IMRT, FDG-PET/CT guided DP-IMRT significantly improved 3-year local failure-free survival (LFFS, 98.8% vs. 91.3%; P = 0.032), locoregional failure-free survival (LRFFS, 97.2 vs. 91.2%; P = 0.049), distant metastasis-free survival (DMFS, 92.9% vs. 87.4%; P = 0.041), disease free survival (DFS, 87.9% vs. 82.4%; P = 0.02), and overall survival (OS, 91.8% vs. 82.6%; P = 0.049). No statistically significant differences in acute and late toxic effects were observed. Multivariate analysis showed that dose painting (PET/CT-guided DP-IMRT vs CT-based IMRT without DP) was a significant independent prognostic factor for LFFS and DFS.

Conclusion: FDG-PET/CT guided DP-IMRT plus chemotherapy is associated with a considerable survival benefit, without increasing toxicity in patients with locoregional advanced NPC. Further randomized trials are needed to fully assess the role of PET/CT-guided DP-IMRT.

Keywords: Dose painting; FDG-PET/CT; Intensity-Modulated Radiation Therapy; Nasopharyngeal carcinoma; Toxicity.

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Figures

Fig. 1
Fig. 1
Kaplan-Meier survival curves for the PET/CT-guided DP-IMRT and CT-based IMRT groups. LFFS (a), RFFS (b), LRFFS (c), DMFS (d), DFS (e) and OS (f). P values were calculated using the log-rank test
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