Recurrences after intensity modulated radiotherapy for head and neck squamous cell carcinoma more likely to originate from regions with high baseline [18F]-FDG uptake.

Anne Kirkebjerg Due, Ivan Richter Vogelius, Marianne Aznar, Søren M. Bentzen, Anne Kiil Berthelsen, Stine Korreman, Annika Loft, Claus Andrup Kristensen, Lena Specht

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    Background and purpose: To analyze the recurrence pattern in relation to target volumes and 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography in head and neck squamous cell carcinoma (HNSCC) patients treated with definitive chemoradiation. Material and methods: 520 patients received radiotherapy for HNSCC from 2005 to 2009. Among 100 patients achieving complete clinical response and a later recurrence, 39 patients with 48 loco-regional failures had a recurrence CT scan before any salvage therapy. The estimated point of origin of each recurrence was transferred to the planning CT by deformable image co-registration. The recurrence position was then related to the delineated target volumes and iso-SUV-contours relative to the maximum standard uptake value (SUV). We defined the recurrence density as the total number of recurrences in a sub-volume divided by the sum of that volume for all patients. Results: 54% (95% CI 37–69%) of recurrences originated inside the FDG-positive volume and 96% (95% CI 86–99%) in the high dose region. Recurrence density was significantly higher in the central target volumes (P < 0.0001) and increased with increasing FDG avidity (P = 0.036). Conclusions: The detailed pattern-of-failure data analysis suggests that most recurrences occur in the FDG PET positive areas or the solid tumor.
    Original languageEnglish
    JournalRadiotherapy & Oncology
    Issue number3
    Pages (from-to)360-365
    Publication statusPublished - 2014


    • FDG-PET
    • Head and neck cancer
    • Pattern of failure
    • Radiotherapy
    • Recurrence

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