Abstract
Radiotherapy (RT) plays an important role in the treatment of lung cancer. Accurate diagnosis and staging are crucial in the delivery of RT with curative intent. Target miss can be prevented by accurate determination of tumor contours during RT planning. Currently, tumor contours are determined manually by computed tomography (CT) during RT planning. This method leads to differences in delineation of tumor volume between users. Given the change in RT tools and methods due to rapidly developing technology, it is now more significant to accurately delineate the tumor tissue. F18 fluorodeoxyglucose positron emission tomography/CT (F18 FDG PET/CT) has been established as an accurate method in correctly staging and detecting tumor dissemination in lung cancer. Since it provides both anatomic and biologic information, F18 FDG PET decreases inter-user variability in tumor delineation. For instance, tumor volumes may be decreased as atelectasis and malignant tissue can be more accurately differentiated, as well as better evaluation of benign and malignant lymph nodes given the difference in FDG uptake. Using F18 FDG PET/CT, the radiation dose can be escalated without serious adverse effects in lung cancer. In this study, we evaluated the contribution of F18 FDG PET/CT for RT planning in lung cancer.
Highlights
External beam radiotherapy (RT) plays an important role in the management of non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) [1,2]
Feasibility studies have found that the use of F18 fluorodeoxyglucose-positron emission tomography (PET)/computed tomography (CT) (F18FDG) for planning three-dimensional conformal radiation therapy improves the standardization of volume delineation as compared to CT alone in several types of cancers that are well imaged on PET [8]
The most important contribution of FDGPET to the management of SCLC is in the accuracy of staging
Summary
External beam radiotherapy (RT) plays an important role in the management of non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) [1,2]. FDG-PET/CT significantly decreases the delineation differences between oncologists, and it provides proper staging by identifying tumor and lymph nodes and determines gross target volume (GTV) more accurately during RT planning process. A dosimetric study of van Der Wel et al [20] evaluating 21 patients with N2 and N3 NSCLC showed that using FDG-PET/ CT in radiation treatment planning process the esophagus and the lungs could be kept in the low dose area while the tumor received a high dose. The ability to identify and differentiate atelectasis led to a decrease in GTV delineation in 3 out of 24 patients planned for 3D conformal RT, while the ability to identify small lymph node metastases via high FDG uptake led to a GTV increase in 10 patients as well as detecting additional parenchymal disease in one patient. Non-small cell lung cancer, a) The atelectatic field cannot be separated from the tumor tissue in computed tomography, b) Positron emission tomography images showed increased fluorodeoxyglucose uptake in the tumor tissue, c and d) It was observed that there was a significant difference in target volumes formed by positron emission tomography/computed tomography fusion images
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