Uniform FDG-PET Guided Gradient Dose Prescription to Reduce Late Radiation Toxicity

Inclusion criteria

• Newly diagnosed tumours classified as stage T2-4 N0-2 (TNM 7th edition 2009) located in the larynx, oropharynx or hypopharynx (unknown primary and oral cavity are not eligible)
• Histopathological diagnosis of invasive squamous cell carcinoma in the primary tumour
• Decision for curative intent external beam radiotherapy with elective treatment of the neck made by a multidisciplinary head-and-neck oncology team. The patient must be expected to complete the treatment.
• Radiotherapy planned to start within 6 weeks from baseline imaging of tumour assessment
• No distant metastasis (M0) (TNM 7th edition 2009)
• WHO performance status 0-2
• ≥ 18 years of age
• Written informed consent

Exclusion criteria

• Concomitant chemotherapy or EGFR inhibitors for this tumour.
• Primary tumour of the oral cavity or unknown primary tumour
• Prior or current anticancer treatment to the head and neck area (e.g. radical attempted or tumour reductive surgery, neo-adjuvant or concomitant chemotherapy, EGFR inhibitors or radiotherapy), except for endoscopic glottic laser micro surgery.
• Current participation in any other oncologic interventional clinical study for this tumor.
• Uncontrolled diabetes mellitus.
• Known or suspected HIV infection.
• History of previous malignancy within the last 3 years, with the exception of surgically cured carcinoma in situ of the cervix, in situ breast cancer, incidental finding of stage T1a or T1b prostate cancer, basal/squamous cell carcinoma of the skin, and other non-invasive malignancies (e.g. in situ carcinomas)..
• Any condition (somatic, psychological, familial, sociological or geographical) rendering the patient unable to understand or complete questionnaires.