Early prediction of survival following induction chemotherapy with DCF (docetaxel, cisplatin, 5-fluorouracil) using FDG PET/CT imaging in patients with locally ... View Full Text


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Article Info

DATE

2012-08-16

AUTHORS

Ronan Abgral, Pierre-Yves Le Roux, Nathalie Keromnes, Jean Rousset, Gérald Valette, Dominique Gouders, Cyril Leleu, Delphine Mollon, Emmanuel Nowak, Solène Querellou, Pierre-Yves Salaün

ABSTRACT

PurposeLocally advanced head and neck squamous cell carcinoma (HNSCC) has a high rate of recurrence. Induction chemotherapy with DCF (docetaxel, cisplatin, 5-fluorouracil) before chemoradiotherapy could lead to the best disease control of inoperable stage III/IV HNSCC but with an increased risk of acute toxicity. Early assessment of therapeutic efficacy is a key issue in considering the benefit of escalation in a poor prognosis population.MethodsPatients with stage III/IV HNSCC, in whom DCF induction chemotherapy followed by concurrent chemoradiotherapy had been validated by a multidisciplinary team, were prospectively included in the study. FDG PET/CT scans were performed in all patients before and after two of the three cycles of DCF. EORTC99 criteria were used to evaluate PET responses as follows: group 1 (metabolic responders) showing a complete response (CR) or partial response (PR), and subgroup 0 (metabolic nonresponders) showing stable disease (SD) or progressive disease (PD). The primary endpoint for monitoring patients was event-free survival (EFS). EFS probabilities between the two groups were estimated by the Kaplan-Meier method and statistically compared using the log-rank test.ResultsFifteen consecutive patients (14 men, 1 woman; age 57.5 ± 6.2 years, mean ± SD) were analysed. Therapeutic assessment by PET/CT demonstrated CR in four patients, PR in six, SD in four and PD in one. Among the ten patients with a metabolic response (group 1), none had relapsed at the time of this report, while four of five patients with no metabolic response (group 0) showed recurrence within an average of 9.0 ± 1.6 months. Median EFS was, respectively, 18.9 months (3.8–25.3 months) and 10.2 months (7.5–12.7 months) in group 1 and group 0. The corresponding 1-year EFS rates were 100 % and 20 %, respectively. The difference in EFS between the two groups was statistically significant (p = 0.0014).ConclusionEarly therapeutic response demonstrated on FDG PET/CT after two cycles of induction chemotherapy with DCF in patients with inoperable stage III/IV HNSCC seems to be a predictive factor for EFS. More... »

PAGES

1839-1847

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00259-012-2213-x

DOI

http://dx.doi.org/10.1007/s00259-012-2213-x

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1048879300

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/22895863


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    "description": "PurposeLocally advanced head and neck squamous cell carcinoma (HNSCC) has a high rate of recurrence. Induction chemotherapy with DCF (docetaxel, cisplatin, 5-fluorouracil) before chemoradiotherapy could lead to the best disease control of inoperable stage III/IV HNSCC but with an increased risk of acute toxicity. Early assessment of therapeutic efficacy is a key issue in considering the benefit of escalation in a poor prognosis population.MethodsPatients with stage III/IV HNSCC, in whom DCF induction chemotherapy followed by concurrent chemoradiotherapy had been validated by a multidisciplinary team, were prospectively included in the study. FDG PET/CT scans were performed in all patients before and after two of the three cycles of DCF. EORTC99 criteria were used to evaluate PET responses as follows: group 1 (metabolic responders) showing a complete response (CR) or partial response (PR), and subgroup 0 (metabolic nonresponders) showing stable disease (SD) or progressive disease (PD). The primary endpoint for monitoring patients was event-free survival (EFS). EFS probabilities between the two groups were estimated by the Kaplan-Meier method and statistically compared using the log-rank test.ResultsFifteen consecutive patients (14\u00a0men, 1\u00a0woman; age 57.5\u2009\u00b1\u20096.2\u00a0years, mean\u2009\u00b1\u2009SD) were analysed. Therapeutic assessment by PET/CT demonstrated CR in four patients, PR in six, SD in four and PD in one. Among the ten patients with a metabolic response (group 1), none had relapsed at the time of this report, while four of five patients with no metabolic response (group 0) showed recurrence within an average of 9.0\u2009\u00b1\u20091.6\u00a0months. Median EFS was, respectively, 18.9\u00a0months (3.8\u201325.3\u00a0months) and 10.2\u00a0months (7.5\u201312.7\u00a0months) in group 1 and group 0. The corresponding 1-year EFS rates were 100\u00a0% and 20\u00a0%, respectively. The difference in EFS between the two groups was statistically significant (p\u2009=\u20090.0014).ConclusionEarly therapeutic response demonstrated on FDG PET/CT after two cycles of induction chemotherapy with DCF in patients with inoperable stage III/IV HNSCC seems to be a predictive factor for EFS.", 
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32 schema:description PurposeLocally advanced head and neck squamous cell carcinoma (HNSCC) has a high rate of recurrence. Induction chemotherapy with DCF (docetaxel, cisplatin, 5-fluorouracil) before chemoradiotherapy could lead to the best disease control of inoperable stage III/IV HNSCC but with an increased risk of acute toxicity. Early assessment of therapeutic efficacy is a key issue in considering the benefit of escalation in a poor prognosis population.MethodsPatients with stage III/IV HNSCC, in whom DCF induction chemotherapy followed by concurrent chemoradiotherapy had been validated by a multidisciplinary team, were prospectively included in the study. FDG PET/CT scans were performed in all patients before and after two of the three cycles of DCF. EORTC99 criteria were used to evaluate PET responses as follows: group 1 (metabolic responders) showing a complete response (CR) or partial response (PR), and subgroup 0 (metabolic nonresponders) showing stable disease (SD) or progressive disease (PD). The primary endpoint for monitoring patients was event-free survival (EFS). EFS probabilities between the two groups were estimated by the Kaplan-Meier method and statistically compared using the log-rank test.ResultsFifteen consecutive patients (14 men, 1 woman; age 57.5 ± 6.2 years, mean ± SD) were analysed. Therapeutic assessment by PET/CT demonstrated CR in four patients, PR in six, SD in four and PD in one. Among the ten patients with a metabolic response (group 1), none had relapsed at the time of this report, while four of five patients with no metabolic response (group 0) showed recurrence within an average of 9.0 ± 1.6 months. Median EFS was, respectively, 18.9 months (3.8–25.3 months) and 10.2 months (7.5–12.7 months) in group 1 and group 0. The corresponding 1-year EFS rates were 100 % and 20 %, respectively. The difference in EFS between the two groups was statistically significant (p = 0.0014).ConclusionEarly therapeutic response demonstrated on FDG PET/CT after two cycles of induction chemotherapy with DCF in patients with inoperable stage III/IV HNSCC seems to be a predictive factor for EFS.
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38 schema:keywords CT
39 CT scan
40 DCF
41 DCF induction chemotherapy
42 EFS probability
43 EFS rates
44 FDG PET/CT
45 FDG PET/CT scans
46 HNSCC
47 Kaplan-Meier method
48 MethodsPatients
49 PET response
50 PET/CT
51 PET/CT scans
52 acute toxicity
53 advanced head
54 assessment
55 average
56 benefits
57 better disease control
58 carcinoma
59 cell carcinoma
60 chemoradiotherapy
61 chemotherapy
62 complete response
63 concurrent chemoradiotherapy
64 consecutive patients
65 control
66 criteria
67 cycle
68 cycles of DCF
69 differences
70 disease
71 disease control
72 early assessment
73 early prediction
74 efficacy
75 endpoint
76 escalation
77 event-free survival
78 factors
79 group
80 group 0
81 group 1
82 head
83 high rate
84 induction chemotherapy
85 issues
86 key issues
87 log-rank test
88 median event-free survival
89 metabolic response
90 method
91 months
92 multidisciplinary team
93 neck squamous cell carcinoma
94 partial response
95 patients
96 poor prognosis population
97 population
98 prediction
99 predictive factors
100 primary endpoint
101 probability
102 progressive disease
103 rate
104 recurrence
105 report
106 response
107 risk
108 scans
109 squamous cell carcinoma
110 stable disease
111 stage III/IV HNSCC
112 study
113 subgroups 0
114 survival
115 team
116 test
117 therapeutic assessment
118 therapeutic efficacy
119 therapeutic response
120 time
121 toxicity
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