Fluorine-18-labeled fluoromisonidazole positron emission and computed tomography-guided intensity-modulated radiotherapy for head and neck cancer:: A feasibility study
Fluorine-18-labeled fluoromisonidazole positron emission and computed tomography-guided intensity-modulated radiotherapy for head and neck cancer:: A feasibility study
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DOI：
10.1016/j.ijrobp.2007.06.039
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发表时间：
2008-01-01
影响因子：
7
通讯作者：
Schoder, Heiko
中科院分区：
文献类型：
--
作者：
Lee, Nancy Y.;Mechalakos, James G.;Schoder, Heiko
目的：缺氧使肿瘤细胞具有放射抗性，限制了局部放疗（RT）的控制。强度调节放射治疗（IMRT）允许靶向肿瘤总体积（GTV），并且可以潜在地向缺氧亚体积（GTV(h)）提供更大的剂量，同时保留正常组织。蒙特卡罗模型表明，提高GTV(h)可以提高肿瘤控制的概率。本研究探讨了氟-18标记的氟米唑正电子发射断层扫描/计算机断层扫描（F-18-FMISO PET/CT）引导的IMRT的可行性，目的是最大限度地将剂量增加到头颈癌（HNC）患者的耐辐射缺氧区。方法与材料：经静脉注射F-18-FMISO进行PET显像。采用相同的固定方法对CT模拟、氟脱氧葡萄糖PET/CT和F-18-FMISO PET/CT扫描进行共登记。通过临床检查和可用的影像学检查（包括氟脱氧葡萄糖PET/CT）确定肿瘤边界。在氟脱氧葡萄糖PET/CT GTV中，F-18-FMISO摄取升高的区域被定位为IMRT增强的目标。对其他靶点和/或正常结构进行轮廓或转移到治疗计划中，以生成F-18-FMISO PET/ ct引导的IMRT计划。结果：GTV内F-18-FMISO的不均匀分布表明肿瘤内不同程度的缺氧。针对10名HNC患者实施F-18-FMISO PET/ ct引导下的IMRT的计划达到了84 Gy的GTV(h)和70 Gy的GTV，没有超过正常组织耐受。我们还尝试在2例患者中向GTV(h)输送105 Gy，并在1例患者中成功，正常组织保留。结论：10例患者均可在不超过正常组织耐受的情况下将GTV(h)剂量提升至84 Gy， 1例患者将GTV(h)剂量提升至105 Gy。这一信息为后续低氧引导下的IMRT试验提供了重要数据，目的是进一步改善HNC患者的局部控制。(c) 2008爱思唯尔公司
Purpose: Hypoxia renders tumor cells radioresistant, limiting locoregional control from radiotherapy (RT). Intensity-modulated RT (IMRT) allows for targeting of the gross tumor volume (GTV) and can potentially deliver a greater dose to hypoxic subvolumes (GTV(h)) while sparing normal tissues. A Monte Carlo model has shown that boosting the GTV(h) increases the tumor control probability. This study examined the feasibility of fluorine-18-labeled fluoromisonidazole positron emission tomography/computed tomography (F-18-FMISO PET/CT)-guided IMRT with the goal of maximally escalating the dose to radioresistant hypoxic zones in a cohort of head and neck cancer (HNC) patients.Methods and Materials: F-18-FMISO was administered intravenously for PET imaging. The CT simulation, fluorodeoxyglucose PET/CT, and F-18-FMISO PET/CT scans were co-registered using the same immobilization methods. The tumor boundaries were defined by clinical examination and available imaging studies, including fluorodeoxyglucose PET/CT. Regions of elevated F-18-FMISO uptake within the fluorodeoxyglucose PET/CT GTV were targeted for an IMRT boost. Additional targets and/or normal structures were contoured or transferred to treatment planning to generate F-18-FMISO PET/CT-guided IMRT plans.Results: The heterogeneous distribution of F-18-FMISO within the GTV demonstrated variable levels of hypoxia within the tumor. Plans directed at performing F-18-FMISO PET/CT-guided IMRT for 10 HNC patients achieved 84 Gy to the GTV(h) and 70 Gy to the GTV, without exceeding the normal tissue tolerance. We also attempted to deliver 105 Gy to the GTV(h) for 2 patients and were successful in 1, with normal tissue sparing.Conclusion: It was feasible to dose escalate the GTV(h) to 84 Gy in all 10 patients and in I patient to 105 Gy without exceeding the normal tissue tolerance. This information has provided important data for subsequent hypoxia-guided IMRT trials with the goal of further improving locoregional control in HNC patients. (c) 2008 Elsevier Inc.