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Open Access 01-12-2010 | Research article

Focal dose escalation using FDG-PET-guided intensity-modulated radiation therapy boost for postoperative local recurrent rectal cancer: a planning study with comparison of DVH and NTCP

Authors: Keiichi Jingu, Hisanori Ariga, Tomohiro Kaneta, Yoshihiro Takai, Ken Takeda, Lindel Katja, Kakutaro Narazaki, Takahiro Metoki, Keisuke Fujimoto, Rei Umezawa, Yoshihiro Ogawa, Kenji Nemoto, Masashi Koto, Masatoshi Mitsuya, Naruhiro Matsufuji, Shoki Takahashi, Shogo Yamada

Published in: BMC Cancer | Issue 1/2010

Abstract

Background

To evaluate the safety of focal dose escalation to regions with standardized uptake value (SUV) >2.0 using intensity-modulated radiation therapy (IMRT) by comparison of radiotherapy plans using dose-volume histograms (DVHs) and normal tissue complication probability (NTCP) for postoperative local recurrent rectal cancer

Methods

First, we performed conventional radiotherapy with 40 Gy/20 fr. (CRT 40 Gy) for 12 patients with postoperative local recurrent rectal cancer, and then we performed FDG-PET/CT radiotherapy planning for those patients. We defined the regions with SUV > 2.0 as biological target volume (BTV) and made three boost plans for each patient: 1) CRT boost plan, 2) IMRT without dose-painting boost plan, and 3) IMRT with dose-painting boost plan. The total boost dose was 20 Gy. In IMRT with dose-painting boost plan, we increased the dose for BTV+5 mm by 30% of the prescribed dose. We added CRT boost plan to CRT 40 Gy (summed plan 1), IMRT without dose-painting boost plan to CRT 40 Gy (summed plan 2) and IMRT with dose-painting boost plan to CRT 40 Gy (summed plan 3), and we compared those plans using DVHs and NTCP.

Results

D_mean of PTV-PET and that of PTV-CT were 26.5 Gy and 21.3 Gy, respectively. V₅₀ of small bowel PRV in summed plan 1 was significantly higher than those in other plans ((summed plan 1 vs. summed plan 2 vs. summed plan 3: 47.11 ± 45.33 cm³ vs. 40.63 ± 39.13 cm³ vs. 41.25 ± 39.96 cm³(p < 0.01, respectively)). There were no significant differences in V₃₀, V₄₀, V₆₀, D_mean or NTCP of small bowel PRV.

Conclusions

FDG-PET-guided IMRT can facilitate focal dose-escalation to regions with SUV above 2.0 for postoperative local recurrent rectal cancer.

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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2407/10/127/prepub

Title: Focal dose escalation using FDG-PET-guided intensity-modulated radiation therapy boost for postoperative local recurrent rectal cancer: a planning study with comparison of DVH and NTCP
Authors: Keiichi Jingu
Hisanori Ariga
Tomohiro Kaneta
Yoshihiro Takai
Ken Takeda
Lindel Katja
Kakutaro Narazaki
Takahiro Metoki
Keisuke Fujimoto
Rei Umezawa
Yoshihiro Ogawa
Kenji Nemoto
Masashi Koto
Masatoshi Mitsuya
Naruhiro Matsufuji
Shoki Takahashi
Shogo Yamada
Publication date: 01-12-2010
Publisher: BioMed Central
Published in: BMC Cancer / Issue 1/2010
Electronic ISSN: 1471-2407
DOI: https://doi.org/10.1186/1471-2407-10-127

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