A Randomized Pilot Trial Comparing Position Emission Tomography (PET)-Guided Dose Escalation Radiotherapy to Conventional Radiotherapy in Chemoradiotherapy Treatment of Locally Advanced Nasopharyngeal Carcinoma |
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Authors: | Jianshe Wang Junnian Zheng Tianyou Tang Feng Zhu Yuanhu Yao Jing Xu Andrew Z Wang Longzhen Zhang |
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Institution: | 1. Department of Radiation Oncology, Affiliated Hospital of Xuzhou Medical College; Cancer Institute of Xuzhou Medical College, Jiangsu, China.; 2. Department of Radiation Oncology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America.; 3. PET-CT Center Xuzhou Central Hospital, Xuzhou, Jiangsu, China.; Colorado State University, UNITED STATES, |
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Abstract: | BackgroundThis 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.Methods67 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.ResultsThe 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.ConclusionsPET/CT-guided dose escalation radiotherapy is well-tolerated and appears to be superior to conventional chemoradiotherapy for locally advanced NPC.Trial RegistrationClinicalTrials.gov NCT02089204 |
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