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Hypoxia imaging with [18F]-FMISO-PET for guided dose escalation with intensity-modulated radiotherapy in head-and-neck cancers

Hypoxie-Bildgebung mit [18F]-FMISO-PET für geführte Dosissteigerung bei intensitätsmodulierter Strahlentherapie bei Kopf-Hals-Tumoren

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Abstract

Background and purpose

Positron emission tomography (PET) with [18F]-fluoromisonidazole ([18F]-FMISO) provides a non-invasive assessment of hypoxia. The aim of this study is to assess the feasibility of a dose escalation with volumetric modulated arc therapy (VMAT) guided by [18F]-FMISO-PET for head-and-neck cancers (HNC).

Patients and methods

Ten patients with inoperable stages III–IV HNC underwent [18F]-FMISO-PET before radiotherapy. Hypoxic target volumes (HTV) were segmented automatically by using the fuzzy locally adaptive Bayesian method. Retrospectively, two VMAT plans were generated delivering 70 Gy to the gross tumour volume (GTV) defined on computed tomography simulation or 79.8 Gy to the HTV. A dosimetric comparison was performed, based on calculations of tumour control probability (TCP), normal tissue complication probability (NTCP) for the parotid glands and uncomplicated tumour control probability (UTCP).

Results

The mean hypoxic fraction, defined as the ratio between the HTV and the GTV, was 0.18. The mean average dose for both parotids was 22.7 Gy and 25.5 Gy without and with dose escalation respectively. FMISO-guided dose escalation led to a mean increase of TCP, NTCP for both parotids and UTCP by 18.1, 4.6 and 8 % respectively.

Conclusion

A dose escalation up to 79.8 Gy guided by [18F]-FMISO-PET with VMAT seems feasible with improvement of TCP and without excessive increase of NTCP for parotids.

Zusammenfassung

Hintergrund und Zielsetzung

Die Positronenemissionstomographie (PET) mit [18F]-Fluoromisonidazol ([18F]-FMISO) ermöglicht eine nichtinvasive Beurteilung der Hypoxie. Ziel dieser Studie ist es, die Durchführbarkeit einer [18F]-FMISO-PET-geführten Dosissteigerung bei volumetrisch modulierter Arc-Therapie (VMAT) von Kopf-Hals-Tumoren (KHT) zu bewerten.

Patienten und Methoden

Zehn Patienten mit inoperablen KHT der Stadien III-IV erhielten vor der Strahlentherapie eine [18F]-FMISO-PET. Hypoxische Zielvolumina (HV) wurden automatisch mit Hilfe des FLAB(Fuzzy Locally Adaptive Bayesian)-Verfahrens segmentiert. Retrospektiv wurden 2 VMAT-Pläne erstellt, mit 70 Gy auf das CT-basierte GTV („gross tumour volume“) bzw. 79,8 Gy auf das HV. Durchgeführt wurde ein Vergleich der Dosimetrie, basierend auf Berechnungen von TCP („tumour control probability“), NTCP („normal tissue complication probability“) für die Glandulae (Gl.) parotidis und UTCP („uncomplicated tumour control probability“).

Ergebnisse

Die mittlere hypoxische Fraktion, definiert als das Verhältnis zwischen HV und GTV, betrug 0,18. Die mittlere durchschnittliche Dosis für beide Parotiden betrug 22,7 Gy ohne und 25,5 Gy mit Dosissteigerung. Die FMISO-geführte Dosissteigerung ergab einen mittleren Anstieg von TCP, NTCP für beide Gl. parotidis und UTCP um 18,1/4,6 bzw. 8 %.

Schlussfolgerung

Eine [18F]-FMISO-PET-geführte Dosissteigerung mit VMAT bis zu 79,8 Gy scheint mit einer Verbesserung der TCP und ohne übermäßige Erhöhung der NTCP für die Gl. parotidis durchführbar zu sein.

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Conflict of interest

B. Henriques de Figueiredo, C. Zacharatou, S. Galland-Girodet, J. Benech, H. De Clermont-Gallerande, F. Lamare, M. Hatt, L. Digue, E. De Mones del Pujol, and P. Fernandez state that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiotherapy, Institut Bergonié, 229, cours de l’Argonne, 33076, BORDEAUX Cedex, France

    B. Henriques de Figueiredo M.D., Ph.D. & C. Zacharatou Ph.D.

  2. INCIA UMR-CNRS 5287, 33076, Bordeaux, France

    B. Henriques de Figueiredo M.D., Ph.D., F. Lamare Ph.D. & P. Fernandez M.D., Ph.D.

  3. Department of Radiotherapy, Hospital Haut-Lévêque, 33076, CHRU Bordeaux, France

    S. Galland-Girodet M.D., J. Benech Ph.D. & F. Lamare Ph.D.

  4. Department of Nuclear Medicine, Hospital Pellegrin, 33076, CHRU Bordeaux, France

    H. De Clermont-Gallerande M.D. & P. Fernandez M.D., Ph.D.

  5. LaTIM INSERM U1101, Brest, France

    M. Hatt Ph.D.

  6. Department of Clinical Oncology, Hospital Saint-André, 33076, CHRU Bordeaux, France

    L. Digue M.D.

  7. Department of Oto-rhino-laryngology, 33076, CHRU Bordeaux, France

    E. De Mones del Pujol M.D.

  8. University Bordeaux 2, 33076, Bordeaux, France

    P. Fernandez M.D., Ph.D.

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  1. B. Henriques de Figueiredo M.D., Ph.D.
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  2. C. Zacharatou Ph.D.
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  7. M. Hatt Ph.D.
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  8. L. Digue M.D.
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Correspondence to B. Henriques de Figueiredo M.D., Ph.D..

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Henriques de Figueiredo, B., Zacharatou, C., Galland-Girodet, S. et al. Hypoxia imaging with [18F]-FMISO-PET for guided dose escalation with intensity-modulated radiotherapy in head-and-neck cancers. Strahlenther Onkol 191, 217–224 (2015). https://doi.org/10.1007/s00066-014-0752-8

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