@article {55, title = {PET-based dose painting in non-small cell lung cancer: Comparing uniform dose escalation with boosting hypoxic and metabolically active sub-volumes.}, journal = {Radiother Oncol}, volume = {116}, year = {2015}, month = {2015 Aug}, pages = {281-6}, abstract = {

BACKGROUND AND PURPOSE: We compared two imaging biomarkers for dose-escalation in patients with advanced non-small cell lung cancer (NSCLC). Treatment plans boosting metabolically active sub-volumes defined by FDG-PET or hypoxic sub-volumes defined by HX4-PET were compared with boosting the entire tumour.

MATERIALS AND METHODS: Ten NSCLC patients underwent FDG- and HX4-PET/CT scans prior to radiotherapy. Three isotoxic dose-escalation plans were compared per patient: plan A, boosting the primary tumour (PTVprim); plan B, boosting sub-volume with FDG >50\% SUVmax (PTVFDG); plan C, boosting hypoxic volume with HX4 tumour-to-background >1.4 (PTVHX4).

RESULTS: Average boost volumes were 507 {\textpm} 466 cm(3) for PTVprim, 173 {\textpm} 127 cm(3) for PTVFDG and 114 {\textpm} 73 cm(3) for PTVHX4. The smaller PTVHX4 overlapped on average 87 {\textpm} 16\% with PTVFDG. Prescribed dose was escalated to 87 {\textpm} 10 Gy for PTVprim, 107 {\textpm} 20 Gy for PTVFDG, and 117 {\textpm} 15 Gy for PTVHX4, with comparable doses to the relevant organs-at-risk (OAR). Treatment plans are available online (https://www.cancerdata.org/10.1016/j.radonc.2015.07.013).

CONCLUSIONS: Dose escalation based on metabolic sub-volumes, hypoxic sub-volumes and the entire tumour is feasible. Highest dose was achieved for hypoxia plans, without increasing dose to OAR. For most patients, boosting the metabolic sub-volume also resulted in boosting the hypoxic volume, although to a lower dose, but not vice versa.

}, keywords = {Aged, Aged, 80 and over, Carcinoma, Non-Small-Cell Lung, Cell Hypoxia, Female, Humans, Lung Neoplasms, Male, Middle Aged, Positron-Emission Tomography, Radiotherapy Dosage, Radiotherapy Planning, Computer-Assisted}, issn = {1879-0887}, doi = {10.1016/j.radonc.2015.07.013}, author = {Even, Aniek J G and van der Stoep, Judith and Zegers, Catharina M L and Reymen, Bart and Troost, Esther G C and Lambin, Philippe and van Elmpt, Wouter} } @article {46, title = {Externally validated HPV-based prognostic nomogram for oropharyngeal carcinoma patients yields more accurate predictions than TNM staging.}, journal = {Radiother Oncol}, volume = {113}, year = {2014}, month = {2014 Dec}, pages = {324-30}, abstract = {

PURPOSE: Due to the established role of the human papillomavirus (HPV), the optimal treatment for oropharyngeal carcinoma is currently under debate. We evaluated the most important determinants of treatment outcome to develop a multifactorial predictive model that could provide individualized predictions of treatment outcome in oropharyngeal carcinoma patients.

METHODS: We analyzed the association between clinico-pathological factors and overall and progression-free survival in 168 OPSCC patients treated with curative radiotherapy or concurrent chemo-radiation. A multivariate model was validated in an external dataset of 189 patients and compared to the TNM staging system. This nomogram will be made publicly available at www.predictcancer.org.

RESULTS: Predictors of unfavorable outcomes were negative HPV-status, moderate to severe comorbidity, T3-T4 classification, N2b-N3 stage, male gender, lower hemoglobin levels and smoking history of more than 30 pack years. Prediction of overall survival using the multi-parameter model yielded a C-index of 0.82 (95\% CI, 0.76-0.88). Validation in an independent dataset yielded a C-index of 0.73 (95\% CI, 0.66-0.79. For progression-free survival, the model{\textquoteright}s C-index was 0.80 (95\% CI, 0.76-0.88), with a validation C-index of 0.67, (95\% CI, 0.59-0.74). Stratification of model estimated probabilities showed statistically different prognosis groups in both datasets (p<0.001).

CONCLUSION: This nomogram was superior to TNM classification or HPV status alone in an independent validation dataset for prediction of overall and progression-free survival in OPSCC patients, assigning patients to distinct prognosis groups. These individualized predictions could be used to stratify patients for treatment de-escalation trials.

}, keywords = {Adult, Aged, Aged, 80 and over, Carcinoma, Squamous Cell, Chemoradiotherapy, Disease-Free Survival, Female, Head and Neck Neoplasms, Humans, Male, Middle Aged, Neoplasm Staging, Nomograms, Oropharyngeal Neoplasms, Papillomaviridae, Polymerase Chain Reaction, Predictive Value of Tests, Prognosis, Reproducibility of Results, Severity of Illness Index, Sex Factors, Squamous Cell Carcinoma of Head and Neck, Treatment Outcome}, issn = {1879-0887}, doi = {10.1016/j.radonc.2014.09.005}, author = {Rios Velazquez, Emmanuel and Hoebers, Frank and Aerts, Hugo J W L and Rietbergen, Michelle M and Brakenhoff, Ruud H and Leemans, Ren{\'e} C and Speel, Ernst-Jan and Straetmans, Jos and Kremer, Bernd and Lambin, Philippe} } Error | CancerData.org

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