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首頁知識期刊發表[期刊發表] Boron Neutron Capture Therapy Followed by Image-Guided Intensity-Modulated Radiotherapy for Locally Recurrent Head and Neck Cancer: A Prospective Phase I/II Trial

[期刊發表] Boron Neutron Capture Therapy Followed by Image-Guided Intensity-Modulated Radiotherapy for Locally Recurrent Head and Neck Cancer: A Prospective Phase I/II Trial

期刊發表

2023-05-15

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Boron Neutron Capture Therapy Followed by Image-Guided Intensity-Modulated Radiotherapy for Locally Recurrent Head and Neck Cancer: A Prospective Phase I/II Trial

 

 Ling-Wei Wang 1 2, Yen-Wan Hsueh Liu 3, Pen-Yuan Chu 2 4, Hong-Ming Liu 5, Jinn-Jer Peir 5, Ko-Han Lin 2 6, Wen-Sheng Huang 7, Wen-Liang Lo 8 9, Jia-Cheng Lee 1, Tzung-Yi Lin 3, Yu-Ming Liu 1 2, Sang-Hue Yen 10

 

1Department of Heavy Ion and Radiation Oncology, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei 11217, Taiwan.

2School of Medicine, National Yang-Ming Chiao Tung University, No. 155, Section 2, Li-Nong Street, Taipei 112304, Taiwan.

3Heron Neutron Medical Corporation, No. 66-2, Shengyi 5th Road, Zhubei City 30261, Taiwan.

4Department of Otolaryngology, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei 11217, Taiwan.

5Nuclear Science and Technology Development Center, National Tsing Hua University, No. 101, Sect 2, Kuang Fu Road, Hsinchu 30013, Taiwan.

6Department of Nuclear Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei 11217, Taiwan.

7Department of Nuclear Medicine, Cheng Hsin General Hospital, No. 45, Cheng Hsin Street, Taipei 11220, Taiwan.

8Department of Stomatology, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei 11217, Taiwan.

9School of Dentistry, National Yang-Ming Chiao Tung University, No. 155, Section 2, Li-Nong Street, Taipei 112304, Taiwan.

10Division of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, No. 111, Section 3, Shing-Long Road, Taipei 116, Taiwan.

  

Abstract

 Background: This trial investigated the efficacy and safety of salvage boron neutron capture therapy (BNCT) combined with image-guided intensity-modulated radiotherapy (IG-IMRT) for recurrent head and neck cancer after prior radiotherapy (RT).

 

Methods: BNCT was administered using an intravenous boronophenylalanine-fructose complex (500 mg/kg) in a single fraction; multifractionated IG-IMRT was administered 28 days after BNCT. For BNCT, the mucosa served as the dose-limiting organ. For IG-IMRT, the clinical target volume (CTV) and the planning target volume (PTV) were generated according to the post-BNCT gross tumor volume (GTV) with chosen margins.

 

Results: This trial enrolled 14 patients, and 12 patients received combined treatment. The median BNCT average dose for the GTV was 21.6 Gy-Eq, and the median IG-IMRT dose for the PTV was 46.8 Gy/26 fractions. After a median (range) follow-up period of 11.8 (3.6 to 53.2) months, five patients had a complete response and four had a partial response. One patient had grade 4 laryngeal edema; another patient had a grade 4 hemorrhage. Most tumor progression occurred within or adjacent to the CTV. The 1-year overall survival and local progression-free survival rates were 56% and 21%, respectively.

 

Conclusion: Despite the high response rate (64%) of this trial, there was a high incidence of in-field and marginal failure with this approach. Future studies combining BNCT with modalities other than radiation may be tried.

 

Keywords: boron neutron capture therapy; boronophenylalanine; head and neck cancer; image-guided intensity-modulated radiotherapy.