18F-FDG PET/CT directed radiotherapy dose escalation in locally advanced esophageal cancer (LAEC), a phase I study

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2025-09-28 DOI:10.1016/j.radonc.2025.111176

Ningning Cheng, Zhixiao Chen, Ying Chen, Ye Hu, Zijie Wang, Xuming Chen, Qianqian Liu, Tingfeng Chen

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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.

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18F-FDG PET/CT定向放疗剂量递增在局部晚期食管癌（LAEC）中的应用，一项I期研究

背景和目的：确定局部晚期食管癌（LAEC）患者在SCRT联合紫杉醇(P)和卡铂(C)治疗后，PET/CT定义的残余代谢性疾病（RMD）的高分割放疗（HFRT）增强的最大耐受剂量（MTD）。材料和方法：符合条件的患者接受标准放化疗（SCRT），每周紫杉醇和卡铂加放射前PET/ ct引导的调强放疗（IG-IMRT）。RMD患者在接受相同化疗的同时接受HFRT增强治疗。使用改进的斐波那契设计增加增强剂量。剂量限制毒性（DLT）定义为≥4级食管炎，≥3级非血液学毒性（恶心/呕吐除外），或≥4级血液学毒性持续bb0.7 天。MTD是最高剂量，≤1 pts发生DLT。结果：21分可评定。SCRT耐受良好。4例患者达到完全代谢缓解（CMR）。DLT发生在28.8和36 Gy。没有达到MTD。最常见的急性级 ≥ 3毒性是食管炎（17 %）和中性粒细胞减少（24 %）。晚期毒性包括1级或2级食管狭窄（n = 5）。总有效率为88 %。中位随访时间为9 个月，局部-区域失败仅发生在1个月。结论：在使用IG-IMRT进行50 Gy SCRT后，对PET/ ct定义的RMD进行36 Gy HFRT增强，导致总复合肿瘤剂量为86 Gy (BED 100.32 Gy)，可以安全地与每周P/C同时交付。MTD仍有待确定。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

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.