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


BACKGROUND
ClinicalTrials.gov NCT02089204.
Department of Radiation Oncology, Affiliated Hospital of Xuzhou Medical College; Cancer Institute of Xuzhou Medical College, Jiangsu, China.
Jianshe
J
Wang
Department of Radiation Oncology, Affiliated Hospital of Xuzhou Medical College; Cancer Institute of Xuzhou Medical College, Jiangsu, China.
Junnian
J
Zheng
Department of Radiation Oncology, Affiliated Hospital of Xuzhou Medical College; Cancer Institute of Xuzhou Medical College, Jiangsu, China.
Tianyou
T
Tang
PET-CT Center Xuzhou Central Hospital, Xuzhou, Jiangsu, China.
Feng
F
Zhu
Department of Radiation Oncology, Affiliated Hospital of Xuzhou Medical College; Cancer Institute of Xuzhou Medical College, Jiangsu, China.
Yuanhu
Y
Yao
Department of Radiation Oncology, Affiliated Hospital of Xuzhou Medical College; Cancer Institute of Xuzhou Medical College, Jiangsu, China.
Jing
J
Xu
Department of Radiation Oncology, Affiliated Hospital of Xuzhou Medical College; Cancer Institute of Xuzhou Medical College, Jiangsu, China; Department of Radiation Oncology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America.
Andrew Z
AZ
Wang
Department of Radiation Oncology, Affiliated Hospital of Xuzhou Medical College; Cancer Institute of Xuzhou Medical College, Jiangsu, China.
Longzhen
L
Zhang
D000328:Adult; D000368:Aged; D002277:Carcinoma; D059248:Chemoradiotherapy; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy*; D010865:Pilot Projects; D049268:Positron-Emission Tomography / Q000379:methods*; D011881:Radiotherapy, Computer-Assisted / Q000009:adverse effects / Q000379:methods*; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult