A Randomized Pilot Trial Comparing Position Emission Tomography (PET)-Guided Dose Escalation Radiotherapy to Conventional Radiotherapy in Chemoradiotherapy Treatment of Locally Advanced Nasopharyngeal Carcinoma

Jianshe Wang, Junnian Zheng, Tianyou Tang, Feng Zhu, Yuanhu Yao, Jing Xu, Andrew Z Wang, Longzhen Zhang, Jianshe Wang, Junnian Zheng, Tianyou Tang, Feng Zhu, Yuanhu Yao, Jing Xu, Andrew Z Wang, Longzhen Zhang

Abstract

Background: This pilot trial is designed to determine whether PET/CT-guided radiotherapy dose escalation can improve local control while minimizing toxicity for the treatment of locally advanced nasopharyngeal carcinoma.

Methods: 67 patients were randomized into the three treatment arms: conventional chemoradiotherapy (group A), CT-guided dose escalation chemoradiotherapy (group B) and PET/CT-guided dose escalation chemoradiotherapy (group C). Radiotherapy was delivered using the simultaneous modulated accelerated radiation therapy (SMART) technique in the dose-escalation treatment arms. Patients received concurrent and adjuvant chemotherapy.

Results: The use of PET/CT significantly changed the treatment volume delineation of the gross tumor volume. 3-year local progression-free (LPF) survival rates of three groups were 83.3%, 90.9% and 100%, respectively. The 3-year regional progression-free survival (RPFS) rates were 95.8%, 95.5% and 100%, respectively. The 3-year disease free survival (DFS) rates were 79.2%, 86.4% and 95.2%, respectively. The 3-year overall survival (OS) rates were 83.3%, 90.9% and 95.2%, respectively. The 3-year disease-free survival (DFS) rates were 79.2%, 86.4% and 95.2%, respectively. No patient had grade 4 late toxicity.

Conclusions: PET/CT-guided dose escalation radiotherapy is well-tolerated and appears to be superior to conventional chemoradiotherapy for locally advanced NPC.

Trial registration: ClinicalTrials.gov NCT02089204.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. CONSORT flow diagram of trial.
Fig 1. CONSORT flow diagram of trial.
Fig 2. Kaplan-Meier survival analysis of the…
Fig 2. Kaplan-Meier survival analysis of the treatment groups.
(a). The 3-year LPF survival rates of three groups. (b). The 3-year DFS rates of three groups. Group A: conventional chemoradiotherapy group; Group B: CT-guided dose escalation chemoradiotherapy group; Group C: PET/CT-guided dose escalation chemoradiotherapy group. The 3-year LPF and DFS were statistically significant between groups A and C (P

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Source: PubMed

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