PMID- 26203925
OWN - NLM
STAT- MEDLINE
DCOM- 20160128
LR  - 20181202
IS  - 1651-226X (Electronic)
IS  - 0284-186X (Linking)
VI  - 54
IP  - 9
DP  - 2015
TI  - Early volume variation of positive lymph nodes assessed by in-room mega voltage 
      CT images predicts risk of loco-regional relapses in head and neck cancer 
      patients treated with intensity-modulated radiotherapy.
PG  - 1490-5
LID - 10.3109/0284186X.2015.1062137 [doi]
AB  - BACKGROUND: We investigated the possibility to early identify non-responding 
      patients based on FDG-PET positive lymph nodes (PNs) volume variation assessed 
      with in-room images. MATERIAL AND METHODS: Twenty-seven head and neck cancer 
      patients with at least one pre-treatment PNs were retrospectively analyzed; they 
      received 54 Gy, 66 Gy, 69 Gy in 30 fractions on precautionary lymph nodal (N), 
      primary (T) and PET positive (BTV) planning target volumes (PTVs), respectively 
      with Helical TomoTherapy (SIB approach). PNs volume changes during treatment were 
      assessed based on megavoltage computed tomography (MVCT) used for image guidance 
      as ratio between volumes at fractions 10/20/30 and at first fraction. Data on T, 
      N and M relapses (rT, rN, rM) were collected for all patients. The difference of 
      PNs volume changes, during treatment, between patients with versus without 
      relapses was tested (Mann-Whitney test). The impact of shrinkage on the 
      corresponding survival curves (Cox proportional-hazard regression), dividing 
      between no/moderate versus large shrinkage (based on ROC curve best cut-off 
      value) was also investigated. RESULTS: Median follow-up was 27.4 m (3.7-108.9). 
      The numbers for rT, rN, rM were 5, 4, 6, respectively. Differences in PNs 
      shrinkage were found between patients with and without rT/rN at all considered 
      timing [fr 20, rT: 0.56 vs. 1.07 (median), p = 0.06; rN: 0.57 vs. 1.25, p = 
      0.07]. Differences were lower for rM. Survival curves provide high hazard ratios 
      (HR) between PNs changes and rT/rN at all considered timing [fr 20, rT: best 
      cut-off = 0.58, HR 5.1 (95% CI 0.5-49.4), p = 0.12; rN: best cut-off = 0.98, HR 
      14.9 (1.6-142.9), p = 0.01]. CONCLUSION: A limited shrinkage of PNs during 
      treatment is associated with poorer outcome in terms of T/N relapses. The early 
      variation of PNs observed on in-room images may provide useful information about 
      the individual response with potential application in guiding an early adaptation 
      of the treatment.
FAU - Belli, Maria Luisa
AU  - Belli ML
AD  - a Medical Physics, S. Raffaele Scientific Institute , Milano , Italy.
FAU - Fiorino, Claudio
AU  - Fiorino C
AD  - a Medical Physics, S. Raffaele Scientific Institute , Milano , Italy.
FAU - Zerbetto, Flavia
AU  - Zerbetto F
AD  - b Radiotherapy, S. Raffaele Scientific Institute , Milano , Italy.
FAU - Raso, Roberta
AU  - Raso R
AD  - a Medical Physics, S. Raffaele Scientific Institute , Milano , Italy.
FAU - Broggi, Sara
AU  - Broggi S
AD  - a Medical Physics, S. Raffaele Scientific Institute , Milano , Italy.
FAU - Chiara, Anna
AU  - Chiara A
AD  - b Radiotherapy, S. Raffaele Scientific Institute , Milano , Italy.
FAU - Cattaneo, Giovanni Mauro
AU  - Cattaneo GM
AD  - a Medical Physics, S. Raffaele Scientific Institute , Milano , Italy.
FAU - Di Muzio, Nadia
AU  - Di Muzio N
AD  - b Radiotherapy, S. Raffaele Scientific Institute , Milano , Italy.
FAU - Dell'oca, Italo
AU  - Dell'oca I
AD  - b Radiotherapy, S. Raffaele Scientific Institute , Milano , Italy.
FAU - Calandrino, Riccardo
AU  - Calandrino R
AD  - a Medical Physics, S. Raffaele Scientific Institute , Milano , Italy.
LA  - eng
PT  - Journal Article
DEP - 20150723
PL  - Sweden
TA  - Acta Oncol
JT  - Acta oncologica (Stockholm, Sweden)
JID - 8709065
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Dose Fractionation, Radiation
MH  - Female
MH  - Follow-Up Studies
MH  - Head and Neck Neoplasms/pathology/*radiotherapy
MH  - Humans
MH  - Lymph Nodes/*diagnostic imaging/pathology
MH  - Male
MH  - Middle Aged
MH  - Neoplasm Recurrence, Local/*pathology
MH  - *Radiotherapy, Image-Guided
MH  - *Radiotherapy, Intensity-Modulated
MH  - Retrospective Studies
MH  - Tomography, Spiral Computed
EDAT- 2015/07/24 06:00
MHDA- 2016/01/29 06:00
CRDT- 2015/07/24 06:00
PHST- 2015/07/24 06:00 [entrez]
PHST- 2015/07/24 06:00 [pubmed]
PHST- 2016/01/29 06:00 [medline]
AID - 10.3109/0284186X.2015.1062137 [doi]
PST - ppublish
SO  - Acta Oncol. 2015;54(9):1490-5. doi: 10.3109/0284186X.2015.1062137. Epub 2015 Jul 
      23.