{"title":"18F-FDG PET/CT directed radiotherapy dose escalation in locally advanced esophageal cancer (LAEC), a phase I study","authors":"Ningning Cheng, Zhixiao Chen, Ying Chen, Ye Hu, Zijie Wang, Xuming Chen, Qianqian Liu, Tingfeng Chen","doi":"10.1016/j.radonc.2025.111176","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and purpose</h3><div>To determine the maximum tolerated dose (MTD) of hyperfractionated radiotherapy (HFRT) boost for residual metabolic disease (RMD) as defined by PET/CT following SCRT with concurrent paclitaxel (P) and carboplatin (C) for locally advanced esophageal cancer (LAEC).</div></div><div><h3>Materials and methods</h3><div>Eligible patients received standard chemoradiation therapy(SCRT) with weekly paclitaxel and carboplatin plus preirradiation PET/CT-guided intensity-modulated radiotherapy (IG-IMRT). Patients with RMD received HFRT boost concurrent with the same chemotherapy. Boost doses were escalated using a modified Fibonacci design. Dose limiting toxicity (DLT) was defined as grade ≥4 esophagitis, grade ≥3 non-hematological toxicity (except nausea/vomiting), or grade ≥4 hematological toxicity lasting >7 days. MTD was the highest dose with ≤1 pts experiencing DLT.</div></div><div><h3>Results</h3><div>21pts were assessable. SCRT was well-tolerated. 4 pts achieved complete metabolic response (CMR). DLT occurred at 28.8 and 36 Gy. The MTD wasn’t reached. The most common acute grade ≥ 3 toxicities were esophagitis (17 %), neutropenia (24 %). Late toxicity included grade 1 or 2 esophageal stricture (n = 5). Overall response rate was 88 %. With median follow-up of 9 months, local–regional failure only occurred in 1pt.</div></div><div><h3>Conclusion</h3><div>36 Gy HFRT boost to PET/CT-defined RMD after 50 Gy SCRT using IG-IMRT, resulting in a total composite tumor dose of 86 Gy (BED 100.32 Gy), can be safely delivered concurrent with weekly P/C. MTD remains to be defined.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"213 ","pages":"Article 111176"},"PeriodicalIF":5.3000,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Radiotherapy and Oncology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0167814025051801","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background and purpose
To determine the maximum tolerated dose (MTD) of hyperfractionated radiotherapy (HFRT) boost for residual metabolic disease (RMD) as defined by PET/CT following SCRT with concurrent paclitaxel (P) and carboplatin (C) for locally advanced esophageal cancer (LAEC).
Materials and methods
Eligible patients received standard chemoradiation therapy(SCRT) with weekly paclitaxel and carboplatin plus preirradiation PET/CT-guided intensity-modulated radiotherapy (IG-IMRT). Patients with RMD received HFRT boost concurrent with the same chemotherapy. Boost doses were escalated using a modified Fibonacci design. Dose limiting toxicity (DLT) was defined as grade ≥4 esophagitis, grade ≥3 non-hematological toxicity (except nausea/vomiting), or grade ≥4 hematological toxicity lasting >7 days. MTD was the highest dose with ≤1 pts experiencing DLT.
Results
21pts were assessable. SCRT was well-tolerated. 4 pts achieved complete metabolic response (CMR). DLT occurred at 28.8 and 36 Gy. The MTD wasn’t reached. The most common acute grade ≥ 3 toxicities were esophagitis (17 %), neutropenia (24 %). Late toxicity included grade 1 or 2 esophageal stricture (n = 5). Overall response rate was 88 %. With median follow-up of 9 months, local–regional failure only occurred in 1pt.
Conclusion
36 Gy HFRT boost to PET/CT-defined RMD after 50 Gy SCRT using IG-IMRT, resulting in a total composite tumor dose of 86 Gy (BED 100.32 Gy), can be safely delivered concurrent with weekly P/C. MTD remains to be defined.
期刊介绍:
Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.