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| Home > Publications database > De-escalation of elective radiotherapy guided by FDG-PET lowers modeled late swallowing-related toxicity in head and neck cancer |
| Home > Publications database > De-escalation of elective radiotherapy guided by FDG-PET lowers modeled late swallowing-related toxicity in head and neck cancer |
| Journal Article | DKFZ-2026-00925 |
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2026
Elsevier
Amsterdam
Abstract: Purpose: Whether FDG-PET–guided de-escalation of elective target volumes in radiotherapy of the head and neckreduces late toxicity remains uncertain. Therefore, we compared predicted toxicity of two de-escalation strategies—reduced elective nodal irradiation (RNI) and involved node irradiation (INI)—with standard electivenodal irradiation (ENI).Materials and Methods: In a within-patient plan comparison (n = 26), we generated RNI and INI plans using thesame FDG-PET informed high-/intermediate-risk targets as ENI. RNI limited elective volumes to within 2 cmcranio-caudal from gross disease; INI omitted elective treatment. Proton plans were created in representativeoropharyngeal cases. Co-primary outcomes were six-month normal-tissue complication probabilities (NTCPs) fordysphagia, feeding-tube dependence, and xerostomia.Results: Median total planning target volume decreased from 540 cm3 (ENI) to 418 cm3 (RNI) and 173 cm3 (INI).RNI and INI reduced modeled dysphagia risk by 5.9 percentage points (pp) (95% CI 2.3 to 9.6 pp; padj = 0.005)and 11.0 pp (6.9 to 15.2 pp; padj < 0.001), feeding-tube dependence by 2.8 pp (1.2 to 4.5 pp; padj = 0.005) and4.2 pp (2.5 to 6.0 pp; padj < 0.001), and xerostomia by 2.8 pp (0.0 to 5.7 pp; padj = 0.054) and 8.8 pp (5.5 to 12.2pp; padj < 0.001), respectively. Predicted benefits were greatest in hypopharyngeal and laryngeal cancers. Inselected cases, de-escalated proton therapy further reduced organ-at-risk dose.Conclusions: FDG-PET–guided volumetric de-escalation was associated with lower modeled late swallowingrelated toxicity. These findings support the rationale for ongoing and future trials investigating volumetric deescalation strategies.
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