A Randomized Pilot Trial Comparing Position Emission Tomography (PET)-Guided Dose Escalation Radiotherapy to Conventional Radiotherapy in Chemoradiotherapy Treatment of Locally Advanced Nasopharyngeal Carcinoma

PLoS One. 2015 Apr 27;10(4):e0124018. doi: 10.1371/journal.pone.0124018. eCollection 2015.

Abstract

Background: This 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.

Methods: 67 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.

Results: The 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.

Conclusions: PET/CT-guided dose escalation radiotherapy is well-tolerated and appears to be superior to conventional chemoradiotherapy for locally advanced NPC.

Trial registration: ClinicalTrials.gov NCT02089204.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Carcinoma
  • Chemoradiotherapy
  • Chemotherapy, Adjuvant
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nasopharyngeal Carcinoma
  • Nasopharyngeal Neoplasms / drug therapy
  • Nasopharyngeal Neoplasms / pathology*
  • Nasopharyngeal Neoplasms / radiotherapy*
  • Pilot Projects
  • Positron-Emission Tomography / methods*
  • Radiotherapy, Computer-Assisted / adverse effects
  • Radiotherapy, Computer-Assisted / methods*
  • Survival Analysis
  • Tomography, X-Ray Computed / adverse effects
  • Tomography, X-Ray Computed / methods*
  • Treatment Outcome
  • Young Adult

Associated data

  • ClinicalTrials.gov/NCT02089204

Grants and funding

This study was supported by grants from the National Natural Science Foundation of China (No. 81071831), Jiangsu Provincial Health Bureau issues (No. H201021) and Xuzhou City Science and Technology Bureau issues (No. XF10C082). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.