Abstract
The increasing interest in combined positron emission tomography (PET) and computed tomography (CT) to guide lung cancer radiation therapy planning has been well documented. Motion management strategies during treatment simulation PET/CT imaging and treatment delivery have been proposed to improve the precision and accuracy of radiotherapy. In light of these research advances, why has translation of motion-managed PET/CT to clinical radiotherapy been slow and infrequent? Solutions to this problem are as complex as they are numerous, driven by large inter-patient variability in tumor motion trajectories across a highly heterogeneous population. Such variation dictates a comprehensive and patient-specific incorporation of motion management strategies into PET/CT-guided radiotherapy rather than a one-size-fits-all tactic. This review summarizes challenges and opportunities for clinical translation of advances in PET/CT-guided radiotherapy, as well as in respiratory motion-managed radiotherapy of lung cancer. These two concepts are then integrated into proposed patient-specific workflows that span classification schemes, PET/CT image formation, treatment planning, and adaptive image-guided radiotherapy delivery techniques.
Highlights
Lung cancer is the leading cause of cancer mortality worldwide, resulting in 1.4 million deaths annually [1]
The achievable therapeutic ratio of radiotherapy may be improved by image-guided dose intensification to PETdefined biological target volumes that are at highest risk of recurrence, and dose sparing of functional lung volumes that are at highest risk of complication
The workflows are characterized by many distinct components: patient classification, positron emission tomography (PET)/computed tomography (CT) image acquisition and reconstruction, target and prescription definition, radiotherapy planning, treatment plan quality assurance, image-guided radiotherapy delivery, and adaptive procedures
Summary
Lung cancer is the leading cause of cancer mortality worldwide, resulting in 1.4 million deaths annually [1]. The workflows are characterized by many distinct components: patient classification, PET/CT image acquisition and reconstruction, target and prescription definition, radiotherapy planning, treatment plan quality assurance, image-guided radiotherapy delivery, and adaptive procedures.
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