Planning study for available dose of hypoxic tumor volume using fluorine-18-labeled fluoromisonidazole positron emission tomography for treatment of the head and neck cancer

초록

Purpose: To investigate the feasibility of fluorine-18-labeled fluoromisonidazole positron emission tomography/computed tomograph (F-18-FMISO PET/CT)-guided intensity-modulated radiotherapy (IMRT) in dose escalation to attack the hypoxic volume of a tumor mass without increasing the normal tissue dose in head and neck cancer patients. Materials and methods: Eight consecutive head and neck cancer patients underwent F-18-FMISO PET/CT simulation. Hypoxic tumor volue (HTV) was defined using a tumor-to-cerebellum ratio (T/C) of 1.3 as the threshold for F-18-FMISO PET/CT. Dose-escalation plans for treating HTVs using F-18-FMISO PET/CT-guided IMRT were performed for these patients. The standard plan was 72 Gy to the gross tumor volume (GTV) administered as 30 daily fractions of 2.4 Gy. In biologically optimized IMRT plans, the daily dose to the HTV ranged from 2.6 to 3.6 Gy. Dose-volume histogragas (DVHs) were generated as part of each plan, and results of planning were analyzed. Results: Dose-escalation IMRT plans, develivering 30 daily dose of 2.6 Gy (total of 78 Gy) to the HTVs without increases in normal tissue doses, were feasible for six patients. Further acceptable dose escalation on HTV depended primarily on primary tumor site and the extent of disease. Conclusions: It was possible to does-escalate the HTV radiation to 78 Gy in six of eight head and neck cancer patients using F-18-FMISO PET/CT-guided IMRT. (C) 2010 Elsevier Ireland Ltd. All rights reserved. Randiotherapy and Oncology 97 (2010) 176-182

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