Abstract
In the thorax, the extent of tumor may be more accurately defined with the addition of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) to computed tomography (CT). This led to the increased utility of FDG-PET or PET/CT in the treatment planning of radiotherapy for non-small cell lung cancer (NSCLC). The inclusion of FDG-PET information in target volume delineation not only improves tumor localization but also decreases the amount of normal tissue included in the planning target volume (PTV) in selected patients. Therefore, it has a critical role in image-guided radiotherapy (IGRT) for NSCLC. In this review, the impact of FDG-PET on target volume delineation in radiotherapy for NSCLC, which may increase the possibility of safe dose escalation with IGRT, the commonly used methods for tumor target volume delineation FDG-PET for NSCLC, and its impact on clinical outcome will be discussed.
Highlights
In recent years, 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has emerged to be an essential tool in the staging of non-small cell lung cancer (NSCLC) [1]
The impact of FDG-PET on radiotherapy target volume delineation for NSCLC, which may increase the likelihood of dose escalation with image-guided radiotherapy (IGRT), the commonly used methods of defining gross tumor on FDG-PET, 4D-PET/computed tomography (CT) imaging, and FDG-PET’s impact on treatment outcome will be discussed
This is well illustrated by Bradley et al, who demonstrated planning target volume (PTV) and stage alteration of 58 and 31% in patients with stage I-III NSCLC when FDG-PET was incorporated in target volume delineation [9]
Summary
18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has emerged to be an essential tool in the staging of non-small cell lung cancer (NSCLC) [1]. Most prominent changes are often associated with the presence of atelectasis in the treated areas (Figure 1), or the identification of additional nodal disease, which is difficult to visualize on CT [6,7,8,9, 11, 14] (Figure 2) This is well illustrated by Bradley et al, who demonstrated PTV and stage alteration of 58 and 31% in patients with stage I-III NSCLC when FDG-PET was incorporated in target volume delineation [9]. GTV-reduction due to the utilization of PET resulted in dose reduction to the normal lungs and esophagus in patients with tumor-related atelectasis in this study, which suggests a potential advantage in the sparing of thoracic organs at risk (OAR) with the incorporation of FDGPET in target volume delineation. PET-related exclusion of metabolically inactive lymph www.frontiersin.org
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
