Dose Painting in Radiotherapy for Head and Neck Squamous Cell Carcinoma: Value of Repeated Functional Imaging with 18F-FDG PET, 18F-Fluoromisonidazole PET, Diffusion-Weighted MRI, and Dynamic Contrast-Enhanced MRI

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FIGURE 1.
Treatment and imaging protocol.
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FIGURE 2.
Actuarial disease-free survival according to T/B_max before radiotherapy (n = 12). High T/B_max is defined as a value greater than or equal to median of 1.45.
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FIGURE 3.
Actuarial disease-free survival according to T/B_max during radiotherapy (n = 15). High T/B_max is defined as a value greater than or equal to median of 1.17.
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FIGURE 4.
(A and B) Pretreatment ¹⁸F-FDG PET showed metastatic adenopathy at level 2 (arrow) (A), which remained hypoxic on ¹⁸F-fluoromisonidazole PET scan during RT treatment (week 4) (B). (C and D) This lymph node still had restricted apparent diffusion coefficient on DW MRI at 3 wk after end of radiotherapy (C) and remained suspect on ¹⁸F-FDG PET at 8 wk after treatment (D). (E) Residual disease was confirmed in this node (patient 8).

TABLE 1

Patient and Tumor Characteristics

Patient no.	Primary tumor site	Age (y)	Sex	cT	cN	GTV_CT (mL)	Disease recurrence
1	Hypopharynx	59	M	4a	1	46.38	No
2	Hypopharynx	58	F	1	2b	17.82	No
3	Larynx	48	M	3	0	23.06	No
4	Oropharynx	57	M	3	2b	19.08	DM
5	Oropharynx	48	M	2	2c	16.96	LR + DM
6	Oropharynx	60	M	2	2c	19.9	LR + DM
7	Oropharynx	48	M	4a	1	42.3	No
8	Oropharynx	55	M	4a	1	28.01	LR + DM
9	Oropharynx	58	M	2	2b	14.53	LR + DM
10	Larynx	58	M	3	2b	68.34	No
11	Larynx	60	M	4a	2c	20.47	LR
12	Hypopharynx	46	M	4a	1	19.37	No
13	Larynx	51	F	4a	2c	33.82	No
14	Larynx	61	M	1	2c	84.97	DM
15	Oral cavity	55	M	4a	2c	48.51	No

cT = clinical T classification; cN = clinical N classification; DM = distant metastases; LR = locoregional recurrence.

TABLE 2

PET Data