Radiotherapy treatment planning for patients with non-small cell lung cancer using positron emission tomography (PET) Journal Article
| Authors: | Erdi, Y. E.; Rosenzweig, K.; Erdi, A. K.; Macapinlac, H. A.; Hu, Y. C.; Braban, L. E.; Humm, J. L.; Squire, O. D.; Chui, C. S.; Larson, S. M.; Yorke, E. D. |
| Article Title: | Radiotherapy treatment planning for patients with non-small cell lung cancer using positron emission tomography (PET) |
| Abstract: | Purpose: Many patients with non-small cell lung cancer (NSCLC) receive external beam radiation therapy as part of their treatment. Three-dimensional conformal radiation therapy (3DCRT) commonly uses computed tomography (CT) to accurately delineate the target lesion and normal tissues. Clinical studies, however, indicate that positron emission tomography (PET) has higher sensitivity than CT in detecting and staging of mediastinal metastases. Imaging with fluoro-2-deoxyglucose (FDG) PET in conjunction with CT, therefore, can improve the accuracy of lesion definition. In this pilot study, we investigated the potential benefits of incorporating PET data into the conventional treatment planning of NSCLC. Case-by-case, we prospectively analyzed planning target volume (PTV) and lung toxicity changes for a cohort of patients. Materials and methods: We have included 11 patients in this study. They were immobilized in the treatment position and CT simulation was performed. Following CT simulation, PET scanning was performed in the treatment position using the same body cast that was produced for CT simulation and treatment. The PTV, along with the gross target volume (GTV) and normal organs, was first delineated using the CT data set. The CT and PET transmission images were then registered in the treatment planning system using either manual or automated methods, leading to consequent registration of the CT and emission images. The PTV was then modified using the registered PET emission images. The modified PTV is seen simultaneously on both CT and PET images, allowing the physician to define the PTV utilizing the information from both data sets. Dose-volume histograms (DVHs) for lesion and normal organs were generated using both CT-based and PET+CT-based treatment plans. Results: For all patients, there was a change in PTV outline based on CT images versus CT/PET fused images. In seven out of 11 cases, we found an increase in PTV volume (average increase of 19%) to incorporate distant nodal disease. Among these patients, the highest normal-tissue complication probability (NTCP) for lung was 22% with combined PET/CT plan and 21% with CT-only plan. In other four patients PTV was decreased an average of 18%. The reduction of PTV in two of these patients was due to excluding atelectasis and trimming the target volume to avoid delivering higher radiation doses to nearby spinal cord or heart. Conclusions: The incorporation of PET data improves definition of the primary lesion by including positive lymph nodes into the PTV. Thus, the PET data reduces the likelihood of geographic misses and hopefully improves the chance of achieving local control. © 2002 Elsevier Science Ireland Ltd. All rights reserved. |
| Keywords: | adult; clinical article; controlled study; aged; aged, 80 and over; middle aged; clinical trial; cancer localization; treatment planning; radiation dose; cancer staging; positron emission tomography; cancer diagnosis; lymphatic metastasis; diagnostic accuracy; radiopharmaceuticals; computer assisted tomography; controlled clinical trial; tumor volume; lung disease; carcinoma, non-small-cell lung; lung neoplasms; radiotherapy dosage; lung cancer; diagnostic imaging; radiation injury; lung small cell cancer; pilot projects; spinal cord; fluorodeoxyglucose f18; atelectasis; radiotherapy planning, computer-assisted; cancer control; computer assisted radiotherapy; radiation dose distribution; heart; tomography, emission-computed; mediastinum metastasis; humans; human; male; female; priority journal; article |
| Journal Title: | Radiotherapy and Oncology |
| Volume: | 62 |
| Issue: | 1 |
| ISSN: | 0167-8140 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2002-01-01 |
| Start Page: | 51 |
| End Page: | 60 |
| Language: | English |
| DOI: | 10.1016/s0167-8140(01)00470-4 |
| PUBMED: | 11830312 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Export Date: 14 November 2014 -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
Related MSK Work