Comparison of Standardized Uptake Value–Based Positron Emission Tomography and Computed Tomography Target Volumes in Esophageal Cancer Patients Undergoing Radiotherapy

Vali, F.; Nagda, S.; Hall, William A.; Sinacore, James; Gao, M.; Lee, Steven H.; Hong, Robert; Shoup, Margo; Emami, Bahman

doi:10.1016/j.ijrobp.2009.09.022

Cited by 31 publications

(44 citation statements)

References 18 publications

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“…In our dataset, treatment planning was based on initial CT scans and either 18 F-fluorodeoxyglucose PET/CT or endoscopic clip markings of the macroscopic tumor borders. PET/CT has been investigated as a means of delineating esophageal tumors and detecting metastatic lymph nodes for incorporation into the radiation treatment volume [31–33]. In a study published by Muijs et al beneficial effects of PET/CT-based radiotherapy planning were demonstrated regarding target dose coverage and normal tissue complication probabilities [34].…”

Section: Resultsmentioning

confidence: 99%

Intensity modulated radiotherapy (IMRT) with concurrent chemotherapy as definitive treatment of locally advanced esophageal cancer

et al. 2014

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BackgroundTo report our experience with increased dose intensity-modulated radiation and concurrent systemic chemotherapy as definitive treatment of locally advanced esophageal cancer.Patients and methodsWe analyzed 27 consecutive patients with histologically proven esophageal cancer, who were treated with increased-dose IMRT as part of their definitive therapy. The majority of patients had T3/4 and/or N1 disease (93%). Squamous cell carcinoma was the dominating histology (81%). IMRT was delivered in step-and-shoot technique in all patients using an integrated boost concept. The boost volume was covered with total doses of 56-60 Gy (single dose 2-2.14 Gy), while regional nodal regions received 50.4 Gy (single dose 1.8 Gy) in 28 fractions. Concurrent systemic therapy was scheduled in all patients and administered in 26 (96%). 17 patients received additional adjuvant systemic therapy. Loco-regional control, progression-free and overall survival as well as acute and late toxicities were retrospectively analyzed. In addition, quality of life was prospectively assessed according to the EORTC QLQs (QLQ-OG25, QLQ-H&N35 and QLQ-C30).ResultsRadiotherapy was completed as planned in all but one patient (96%), and 21 patients received more than 80% of the planned concurrent systemic therapy. We observed ten locoregional failures, transferring into actuarial 1-, 2- and 3-year-locoregional control rates of 77%, 65% and 48%. Seven patients developed distant metastases, mainly to the lung (71%). The actuarial 1-, 2- and 3-year-disease free survival rates were 58%, 48% and 36%, and overall survival rates were 82%, 61% and 56%. The concept was well tolerated, both in the clinical objective examination and also according to the subjective answers to the QLQ questionnaire. 14 patients (52%) suffered from at least one acute CTC grade 3/4 toxicity, mostly hematological side effects or dysphagia. Severe late toxicities were reported in 6 patients (22%), mostly esophageal strictures and ulcerations. Severe side effects to skin, lung and heart were rare.ConclusionIMRT with concurrent systemic therapy in the definitive treatment of esophageal cancer using an integrated boost concept with doses up to 60 Gy is feasible and yields good results with acceptable acute and late overall toxicity and low side effects to skin, lung and heart.

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Section: Resultsmentioning

confidence: 99%

Intensity modulated radiotherapy (IMRT) with concurrent chemotherapy as definitive treatment of locally advanced esophageal cancer

et al. 2014

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“…PET/CT-based GTVs of the primary tumor were automatically contoured by using nine different methods: SUV ≥2.0, ≥2.5, ≥3.0, ≥3.5; ≥20%, ≥25%, ≥30%, ≥35%, ≥40% of the maximum SUV max , and visual contouring. The methods were determined by the results of other references 10,13–16. All the noncancerous regions within the GTV PET , including the areas overlaid by the heart, bone, and great vessels, were corrected to exclude manually with the help of the CT component of PET/CT.…”

Section: Methodsmentioning

confidence: 99%

A comparative study of target volumes based on <sup>18</sup>F-FDG PET-CT and ten phases of 4DCT for primary thoracic squamous esophageal cancer

Guo

Zhang

et al. 2017

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PurposeTo investigate the correlations in target volumes based on 18F-FDG PET/CT and four-dimensional CT (4DCT) to detect the feasibility of implementing PET in determining gross target volumes (GTV) for tumor motion for primary thoracic esophageal cancer (EC).MethodsThirty-three patients with EC sequentially underwent contrast-enhanced 3DCT, 4DCT, and 18F-FDG PET-CT thoracic simulation. The internal gross target volume (IGTV)10 was obtained by combining the GTV from ten phases of 4DCT. The GTVs based on PET/CT images were defined by setting of different standardized uptake value thresholds and visual contouring. The difference in volume ratio, conformity index (CI), and degree of inclusion (DI) between IGTV10 and GTVPET was compared.ResultsThe images from 20 patients were suitable for further analysis. The optimal volume ratio of 0.95±0.32, 1.06±0.50, 1.07±0.49 was at standardized uptake value (SUV)2.5, SUV20%, or manual contouring. The mean CIs were from 0.33 to 0.54. The best CIs were at SUV2.0 (0.51±0.11), SUV2.5 (0.53±0.13), SUV20% (0.53±0.12), and manual contouring (0.54±0.14). The mean DIs of GTVPET in IGTV10 were from 0.60 to 0.90, and the mean DIs of IGTV10 in GTVPET ranged from 0.35 to 0.78. A negative correlation was found between the mean CI and different SUV (P=0.000).ConclusionNone of the PET-based contours had both close spatial and volumetric approximation to the 4DCT IGTV10. Further evaluation and optimization of PET as a tool for target identification are required.

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“…These data require confirmation in a larger cohort. There is a lack of a validated method of GTV delineation using PET-CT, including the optimum SUV maximum threshold for delineating the metabolically active volume on the PET-CT [10][11][12][13]. A prior study focusing on cervical cancer showed that the minimum threshold representing tumour volume was 40% of maximum SUV with values less than this included additional background uptake [35].…”

Section: Discussionmentioning

confidence: 99%

“…PET-CT can assist in identifying the metabolically active tumour but there remains uncertainty in how this information should be used [9][10][11][12]. Some studies suggest PET-CT may enable more accurate tumour delineation, compared to CT alone [6,9,13].…”

Section: Introductionmentioning

confidence: 99%

Superiority of Deformable Image Co-registration in the Integration of Diagnostic Positron Emission Tomography-Computed Tomography to the Radiotherapy Treatment Planning Pathway for Oesophageal Carcinoma

et al. 2016

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Comparison of Standardized Uptake Value–Based Positron Emission Tomography and Computed Tomography Target Volumes in Esophageal Cancer Patients Undergoing Radiotherapy

Cited by 31 publications

References 18 publications

Intensity modulated radiotherapy (IMRT) with concurrent chemotherapy as definitive treatment of locally advanced esophageal cancer

Intensity modulated radiotherapy (IMRT) with concurrent chemotherapy as definitive treatment of locally advanced esophageal cancer

A comparative study of target volumes based on <sup>18</sup>F-FDG PET-CT and ten phases of 4DCT for primary thoracic squamous esophageal cancer

Superiority of Deformable Image Co-registration in the Integration of Diagnostic Positron Emission Tomography-Computed Tomography to the Radiotherapy Treatment Planning Pathway for Oesophageal Carcinoma

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