Abstract
Radiation therapy is an important component of cancer therapy for early stage as well as locally advanced lung cancer. The use of F18 FDG PET/CT has come to the forefront of lung cancer staging and overall treatment decision-making. FDG PET/CT parameters such as standard uptake value and metabolic tumor volume provide important prognostic and predictive information in lung cancer. Importantly, FDG PET/CT for radiation planning has added biological information in defining the gross tumor volume as well as involved nodal disease. For example, accurate target delineation between tumor and atelectasis is facilitated by utilizing PET and CT imaging. Furthermore, there has been meaningful progress in incorporating metabolic information from FDG PET/CT imaging in radiation treatment planning strategies such as radiation dose escalation based on standard uptake value thresholds as well as using respiratory-gated PET and CT planning for improved target delineation of moving targets. In addition, PET/CT-based follow-up after radiation therapy has provided the possibility of early detection of local as well as distant recurrences after treatment. More research is needed to incorporate other biomarkers such as proliferative and hypoxia biomarkers in PET as well as integrating metabolic information in adaptive, patient-centered, tailored radiation therapy.
Highlights
Lung cancer is the leading cause of cancer death
Recent advances in radiation therapy for non-small cell lung cancer (NSCLC) including intensity-modulated radiotherapy (IMRT), image-guided radiotherapy (IGRT), and stereotactic body radiotherapy (SBRT) have enabled higher radiation doses to be delivered to tumors which increases the tumor local control probability while reducing doses to surrounding normal tissue
Improved targeting of viable tumor based on delineation of metabolically active tumor by F18 FDG PET/CT has been the basis of increased adoption of PET-based radiation treatment planning
Summary
Lung cancer is the leading cause of cancer death. In 2007, the annual incidence was approximately 20,000 and almost 16,000 people died from lung cancer (http://www.cdc.gov/Features/ dsLungCancer). Improved targeting of viable tumor based on delineation of metabolically active tumor by F18 FDG PET/CT has been the basis of increased adoption of PET-based radiation treatment planning. A process by which radiation plans are modified based on changes in tumor volume during treatment enables dose escalation and minimization of normal tissue irradiation (Guckenberger et al, 2011).
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