Recurrences after intensity modulated radiotherapy for head and neck squamous cell carcinoma more likely to originate from regions with high baseline [18F]-FDG uptake

Background and purpose: To analyze the recurrence pattern in relation to target volumes and F-18-fluoro-deoxyglucose (FDG) uptake on positron emission tomography in head and neck squamous cell carcinoma (HNSCC) patients treated with definitive chemoradiation. Material and methods: 520 patients received radiotherapy for HNSCC from 2005 to 2009. Among 100 patients achieving complete clinical response and a later recurrence, 39 patients with 48 loco-regional failures had a recurrence CT scan before any salvage therapy. The estimated point of origin of each recurrence was transferred to the planning CT by deformable image co-registration. The recurrence position was then related to the delineated target volumes and iso-SUV-contours relative to the maximum standard uptake value (SUV). We defined the recurrence density as the total number of recurrences in a sub-volume divided by the sum of that volume for all patients. Results: 54% (95% CI 37-69%) of recurrences originated inside the FDG-positive volume and 96% (95% Cl 86-99%) in the high dose region. Recurrence density was significantly higher in the central target volumes (P < 0.0001) and increased with increasing FDG avidity (P = 0.036). Conclusions: The detailed pattern-of-failure data analysis suggests that most recurrences occur in the FDG PET positive areas or the solid tumor. (C) 2014 Elsevier Ireland Ltd. All rights reserved.