Journal
RADIOTHERAPY AND ONCOLOGY
Volume 155, Issue -, Pages 261-268Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.radonc.2020.10.039
Keywords
Oropharyngeal cancer; Chemoradiotherapy; Toxicity; Survival; Dose painting; FDG PET
Funding
- National Institute for Health Research and Social Care (NIHR) [RP-2-16-07-001]
- EPSRC
- MRC
- Wellcome/EPSRC Centre for Medical Engineering at King's College London [WT 203148/Z/16/Z]
- CRUK
- Department of Health and Social Care (England)
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The FiGaRO trial demonstrated the feasibility and safety of using an FDG-PET-based dose-painting technique for delivering a radiotherapy boost to the FDG-avid primary tumor in patients with oropharyngeal cancer. Despite higher than expected late toxicity rates, the results suggest potential improvement in 3-year survival rates for high-risk patients.
Background and purpose: The FiGaRO trial assessed the feasibility and safety of using an FDG-PET-based dose-painting technique to deliver a radiotherapy (RT) boost to the FDG-avid primary tumour in patients with locally advanced high and intermediate risk oropharyngeal cancer. Materials and method: Patients underwent a planning 18FDG-PET-CT scan, immobilised in the treatment position, after one cycle of induction chemotherapy. The volume of persistent FDG-avidity in the primary tumour was escalated to 71.5 Gy in 30 fractions delivered using a simultaneous integrated boost Intensity Modulated RT (SIB-IMRT) technique. RT was delivered with concomitant Cisplatin following 2 cycles of induction chemotherapy. The primary outcome was the incidence of grade >= 3 late mucosal toxicity 12 months post-treatment, with an excess rate of >10% regarded as unacceptable. Results: Twenty-nine patients were included and twenty-four were treated between 2014 and 2018, in two UK centres. Median follow-up was 36 months (range 4-56 months). Pre-defined planning target volume objectives and organ at risk dose constraints were met in all cases. There were no incidents of acute grade 4 toxicity. There were 4 cases of grade >= 3 mucosal toxicity at 12 months post-treatment (19.1%). There were no cases of persistent mucosal ulceration at 12 months. Overall survival at 3-years was 87.5%, 92.9% for intermediate and 70.0% for high risk patients. Conclusion: Late toxicity rates, although higher than anticipated, are comparable to contemporary published data for standard dose chemo-IMRT. Results suggest improved 3y survival rates for high risk patients. This approach merits further investigation. (C) 2020 Elsevier B.V. All rights reserved.
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