Top

European Journal of Nuclear Medicine and Molecular Imaging

Published in:

01-12-2005 | Original Article

Radiotherapy planning: PET/CT scanner performances in the definition of gross tumour volume and clinical target volume

Authors: Ernesto Brianzoni, Gloria Rossi, Sergio Ancidei, Alfonso Berbellini, Francesca Capoccetti, Carla Cidda, Paola D’Avenia, Sara Fattori, Gian Carlo Montini, Gianluca Valentini, Alfredo Proietti

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 12/2005

Abstract

Purpose

Positron emission tomography is the most advanced scintigraphic imaging technology and can be employed in the planning of radiation therapy (RT). The aim of this study was to evaluate the possible role of fused images (anatomical CT and functional FDG-PET), acquired with a dedicated PET/CT scanner, in delineating gross tumour volume (GTV) and clinical target volume (CTV) in selected patients and thus in facilitating RT planning.

Methods

Twenty-eight patients were examined, 24 with lung cancer (17 non-small cell and seven small cell) and four with non-Hodgkin’s lymphoma in the head and neck region. All patients underwent a whole-body PET scan after a CT scan. The CT images provided morphological volumetric information, and in a second step, the corresponding PET images were overlaid to define the effective target volume. The images were exported off-line via an internal network to an RT simulator.

Results

Three patient were excluded from the study owing to change in the disease stage subsequent to the PET/CT study. Among the remaining 25 patients, PET significantly altered the GTV or CTV in 11 (44%) . In five of these 11 cases there was a reduction in GTV or CTV, while in six there was an increase in GTV or CTV.

Conclusion

FDG-PET is a highly sensitive imaging modality that offers better visualisation of local and locoregional tumour extension. This study confirmed that co-registration of CT data and FDG-PET images may lead to significant modifications of RT planning and patient management.

Bujenovic S. The role of positron emission tomography in radiation treatment planning. Semin Nucl Med 2004;34:293–9CrossRefPubMed

Wahl RL, Quint LE, Greenough RL,Meyer CR, White RI, Orringer MB. Staging of mediastinal non-small cell lung cancer with FDG PET, CT and fusion images preliminary prospective evaluation. Radiology 1994;191:371–7

Gambhir SS, Czernin J, Schwimmer J, Silverman DHS, Coleman RE, Phelps ME. A tabulated summary of the FDG-PET literature. J Nucl Med 2001;42:1S–93SPubMed

Scarfone C, Lavely WC, Cmelak AJ, Delbeke D, Martin WH, Billheimer D, et al. Prospective feasibility trial of radiotherapy target definition for head and neck cancer using 3-dimensional PET and CT imaging. J Nucl Med 2004;45:543–52PubMed

Perez CA, Bradley J, Chao CKS, Grigsby PW, Mutic S, Malyapa R. Functional imaging in treatment planning in radiation therapy: a review. Rays 2002;27:157–73PubMed

Bomanji JB, Costa DC, Ell PJ. Clinical role of positron emission tomography in oncology. Lancet Oncol 2001;2:157–64CrossRefPubMed

Daisne JF, Sibomana M, Bol A, Cosnard G, Lonneux M, Gregoire V. Evaluation of a multimodality image (CT, MRI and PET) coregistration procedure on phantom and head and neck cancer patients: accuracy, reproducibility and consistency. Radiother Oncol 2003;69:237–45CrossRefPubMed

Vanuytsel LJ, Vansteenkiste JF, Stroobants SG, De Leyn PR, De Wever W, Verbeken EK, et al. The impact of¹⁸F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) lymph node staging on the radiation treatment volumes in patients with non-small cell lung cancer. Radiother Oncol 2000;55:317–24CrossRefPubMed

Chapman JD, Bradley JD, Eary JF, Haubner R, Larson SM, Michalski JM, et al. Molecular (functional) imaging for radiotherapy applications: an RTOG symposium. Int J Radiat Oncol Biol Phys 2003;55:294–301CrossRefPubMed

10.

Lardinois D, Weder W, Hany TF, Kamel EM, Korom S, Seifert B, et al. Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography. N Engl J Med 2003;348:2500–7CrossRefPubMed

11.

Miller T, Grigsby P. Measurement of tumor volume by PET to evaluate prognosis in patients with advanced cervical cancer treated with radiation therapy. Int. J Radiat Oncol Biol Phys 2002;53:353–9CrossRefPubMed

12.

Nestle U, Walter K, Schmidt S, Licht N, Nieder C, Motaref B, et al.¹⁸F-deoxyglucose positron emission tomography (FDG-PET) for the planning of radiotherapy in lung cancer: high impact in patients with atelectasis. Int J Radiat Oncol Biol Phys 1999;44:593–7CrossRefPubMed

13.

Giraud P, Elles S, Helfre S, De Rycke Y, Servois V, Carette MF, et al. Conformal radiotherapy for lung cancer: different delineation of the gross tumor volume (GTV) by radiologists and radiation oncologists. Radiother Oncol 2002;62:27–36CrossRefPubMed

14.

Armstrong JG. Target volume definition for three-dimensional conformal radiation therapy of lung cancer. Br J Radiol 1998;71:587–94

15.

Rosenman J. Incorporating functional imaging information into radiation treatments. Semin Radiat Oncol 2001;11:83–92CrossRefPubMed

16.

Hebert ME, Lowe VJ, Hoffman JM, Patz EF, Anscher MS. Positron emission tomography in the pretreatment evaluation and follow-up of non Small Cell Lung Cancer patients treated with radiotherapy: preliminary findings. Am J Clin Oncol 1996;19:416–21CrossRefPubMed

17.

Hu Y, Erdi A, Chui C. A 3D image registration toolkit for radiation therapy treatment planning. Med Phys 1999;26:1160CrossRef

18.

Kiffer JD, Berlangieri SU, Scott AM, Quong G, Feigen M, Schumer W, et al. The contribution of¹⁸F-fluorodeoxyglucose positron emission tomographic imaging to radiotherapy planning in lung cancer. Lung Cancer 1998;19:167–77CrossRefPubMed

19.

Toloza EM, Harpole L, McCrory DC. Noninvasive staging of non-small cell lung cancer: a review of the current evidence. Chest 2003;123:137S–46SCrossRefPubMed

20.

Erdi YE, Rosenzweig K, Erdi AK, Macapinlac HA, Hu YC, Braban LE, et al. Radiotherapy treatment planning for patients with non-small cell lung cancer using positron emission tomography (PET). Radiother Oncol 2002;62:51–60CrossRefPubMed

21.

Bradley JD, Perez CA, Dehdashti F, Siegel BA. Implementing biologic target volumes in radiation treatment planning for non-small cell lung cancer. J Nucl Med 2004;45 (Suppl 1):96–101

22.

Munley MT, Marks LB, Scarfone C, Sibley GS, Patz EF Jr, Turkington TG, et al. Multimodality nuclear medicine imaging in radiation treatment planning for lung cancer: challenges and prospects.Lung Cancer 1999;23:105–14

23.

MacManus MP, Hicks RJ, Ball DL, Kalff V, Matthews JP, Salminen E, et al. F-18 fluorodeoxyglucose positron emission tomography staging in radical radiotherapy candidates with nonsmall cell lung carcinoma: powerful correlation with survival and high impact on treatment. Cancer 2001;92:886–95CrossRefPubMed

24.

Giraud P, GraheK D, Montravers F, Carette MF, Deniaud-Alexandre E, Julia F, et al. CT and¹⁸F-deoxyglucose (FDG) image fusion for optimization of conformal radiotherapy of lung cancers. Int J Radiat Oncol Biol Phys 2001;49:1249–57CrossRefPubMed

25.

Mah K, Caldwell CB, Ung YC, et al. The impact of¹⁸FDG-PET on target and critical organs in CT-based treatment planning or patients with poorly defined non-small-cell lung carcinoma: a prospective study. Int J Radiat Oncol Biol Phys 2002;52:339–50CrossRefPubMed

26.

Ling CC, Humm J, Larson S, Amols H, Fuks Z, Leibel S, et al. Towards multidimensional radiotherapy (MD-CRT): biological imaging and biological conformality. Int J Radiat Oncol Biol Phys 2000;47:551–60CrossRefPubMed

27.

Paulino AC, Johnstone PA. FDG-PET in radiotherapy treatment planning: pandora’s box?. Int J Radiat Oncol Biol Phys 2004;59:4–5CrossRefPubMed

28.

Bradley JD, Thorstad WL, Mutic S, Miller TR, Dehdashti F, Siegel BA, et al. Impact of FDG-PET on radiation therapy volume delineation in non-small cell lung cancer. Int J Radiat Oncol Biol Phys 2004;59:78–85CrossRefPubMed

29.

Van de Wiele C, Lahorte C, Oyen W, Boerman O, Goethals I, Slegers G, et al. Nuclear Medicine Imaging to predict response to radiotherapy: a review. Int J Radiat Oncol Biol Phys 2003;55:5–15CrossRefPubMed

Title: Radiotherapy planning: PET/CT scanner performances in the definition of gross tumour volume and clinical target volume
Authors: Ernesto Brianzoni
Gloria Rossi
Sergio Ancidei
Alfonso Berbellini
Francesca Capoccetti
Carla Cidda
Paola D’Avenia
Sara Fattori
Gian Carlo Montini
Gianluca Valentini
Alfredo Proietti
Publication date: 01-12-2005
Publisher: Springer-Verlag
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 12/2005
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-005-1845-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Radiotherapy planning: PET/CT scanner performances in the definition of gross tumour volume and clinical target volume

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2005

Base-to-apex ventricular activation: Fourier studies in 29 normal individuals

Effective local control of prostate cancer by intratumoral injection of 166Ho-chitosan complex (DW-166HC) in rats

Small cell lung carcinoma invading the pulmonary vein and left atrium as imaged by PET/CT

PET is better than perfusion SPECT for early diagnosis of Alzheimer’s disease

December 2005: Editor’s remarks

Generalised FDG uptake in respiratory muscles after acute respiratory distress