Increased therapeutic ratio by 18FDG-PET CT planning in patients with clinical CT stage N2-N3M0 non–small-cell lung cancer: A modeling study

Wel, A. van der; Nijsten, S.; Hochstenbag, Monique; Lamers, R. J. S.; Boersma, Liesbeth; Wanders, Rinus; Lutgens, Ludy; Zimny, M.; Bentzen, Søren M.; Wouters, Bradly G.; Lambin, Philippe; Ruysscher, Dirk De

doi:10.1016/j.ijrobp.2004.06.205

Cited by 149 publications

(117 citation statements)

References 33 publications

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“…Many studies have shown significant changes in GTV with the inclusion or exclusion of PETdefined nodal areas compared with the CT-generated GTV (35,36). De Ruysscher et al (21), in a prospective clinical study, evaluated the recurrence pattern after visually fused 18 FDG-PET data for selective mediastinal node irradiation in 44 patients with NSCLC.…”

Section: Discussionmentioning

confidence: 99%

18F-Fluorodeoxyglucose Positron Emission Tomography-Based Assessment of Local Failure Patterns in Non–Small-Cell Lung Cancer Treated With Definitive Radiotherapy

Sura

Greco

Gelblum

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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Purpose-To assess the pattern of local failure using 18 F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) scans after radiotherapy (RT) in non-small-cell lung cancer (NSCLC) patients treated with definitive RT whose gross tumor volumes (GTVs) were defined with the aid of pre-RT PET data.Method and Materials-The data from 26 patients treated with involved-field RT who had local failure and a post-RT PET scan were analyzed. The patterns of failure were visually scored and defined as follows: (1) within the GTV/planning target volume (PTV); (2) within the GTV, PTV, and outward; (3) within the PTV and outward; and (4) outside the PTV. Local failure was also evaluated as originating from nodal areas vs. the primary tumor.Results-We analyzed 34 lesions. All 26 patients had recurrence originating from their primary tumor. Of the 34 lesions, 8 (24%) were in nodal areas, 5 of which (63%) were marginal or geographic misses compared with only 1 (4%) of the 26 primary recurrences (p = 0.001). Of the eight primary tumors that had received a dose of <60 Gy, six (75%) had failure within the GTVand two (25%) at the GTV margin. At doses of ≥60 Gy, 6 (33%) of 18 had failure within the GTV and 11 (61%) at the GTV margin, and 1 (6%) was a marginal miss (p < 0.05).Conclusion-At lower doses, the pattern of recurrences was mostly within the GTV, suggesting that the dose might have been a factor for tumor control. At greater doses, the treatment failures were mostly at the margin of the GTV. This suggests that visual incorporation of PET data for GTV delineation might be inadequate, and more sophisticated approaches of PET registration should be evaluated.

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Section: Discussionmentioning

confidence: 99%

18F-Fluorodeoxyglucose Positron Emission Tomography-Based Assessment of Local Failure Patterns in Non–Small-Cell Lung Cancer Treated With Definitive Radiotherapy

Sura

Greco

Gelblum

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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“…The Qualitative Visual Method was used extensively in early attempts to incorporate PET information into the radiation treatment planning process [15][16][17][18][19][20][21] QVM carries personal bias and depends on the window and level set on the PET image by the person performing the target outlining.…”

Section: Introductionmentioning

confidence: 99%

“…Instead, the two target volumes should complement each other into a complex mosaic of biological target volumes. 9 Qualitative Visual Method (QVM); [11] 9 Gross Tumor Volume (GTV)=2.5 standardized uptake value (SUV) units; [12] 9 Linear adaptive SUV threshold function method; [13] GTV=40% of local maximum uptake value (GTV_PET_40) [14].The Qualitative Visual Method was used extensively in early attempts to incorporate PET information into the radiation treatment planning process [15][16][17][18][19][20][21] QVM carries personal bias and depends on the window and level set on the PET image by the person performing the target outlining.The SUV is a useful quantity for diagnostic radiology, where the nuclear medicine specialist has to make a binary decision whether or not the subject has an abnormal uptake in a certain region of the body. However, the SUV as a quantitative expression of the functional activity was argued to be inadequate for radiation treatment planning [14].…”

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confidence: 99%

Towards Biological Target Volumes Definition for Radiotherapy Treatment Planning: Quo Vadis PET/CT?

Dević¹

2013

J Nucl Med Radiat Ther

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IntroductionRadiotherapy treatment planning (RTP) over the last few decades has been based on anatomical targets, namely gross tumor volume (GTV) and from it derived clinical target volume (CTV) as well as the planning target volume (PTV). Owing to its superb spatial reproducibility and the ability to provide the information on electron density (useful for heterogeneity corrections), computed tomography (CT) was, and it still represents, the backbone of modern/high technology radiotherapy treatment planning. The lack of sufficient soft tissue contrast in CT resulted in the incorporation of other imaging methods, such as the magnetic resonance imaging (MRI), into the target definition through the process of image co-registration (sometimes incorrectly termed as image fusion). Whereas the MRI has widely contributed to a better definition of the GTV, [1] which represents an anatomical volume, functional information has not been readily available in the framework of conformal 3D treatment planning and delivery in radiotherapy until recently. In addition, it has been widely accepted that a homogeneous dose delivery to the PTV is the standard of care one should pursue to achieve the best local tumor control.Integration of positron emission tomography (PET) and computed tomography (CT) scanners [2][3][4][5] introduced a new dimension in nuclear medicine by combining functional and anatomical imaging in one machine: the PET/CT scanner. Main advantages of PET/CT scanners are:9 Improved quality of reconstructed PET images with the use of a CT map for attenuation correction of emission PET scans 9 Decrease of about half of the PET acquisition time compared to the previous generation of PET scanners, which used an external radioactive source to acquire transmission scan for attenuation correction. In addition, new faster scintillation materials have also contributed to the shortening of the scanning time 9 The combined medical imaging modality is likely helping management of radiotherapy patients 9 Better understanding of tumor metabolic activity spatial localization by the ability to map the distribution of a specific radiopharmaceutical in co-registered PET/CT images, despite the relatively poor spatial resolution of PET image [6,7].With an increased access to PET/CT information and an apparent appreciation that different sections of the tumor functionally do not behave uniformly, radiation oncologists started to contemplate a change in the traditional concept of uniform dose to the PTV delivery. Instead, a notion of biological targeting and dose painting has come into the play. The first question that comes to our attention is how to define the biological target volumes (BTV) and what do they represent? Ten years after the introduction of the PET/CT scanners into the radiation oncology community, target delineation in radiotherapy treatment planning using FDG-PET/CT scans still has a lot of controversy. The aim of this article is to review the limitations of the current methods for the incorporation of FDG based PET/CT ...

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“…Positron emission tomography (PET) with fluorine‐18‐fluorodeoxyglucose ( 18 F‐FDG) can provide additional functional information on tumor volume 2 , 3 . For non‐small cell lung cancer, it has been recommended to use functional PET images to take into account the biological target characteristics 4 , 6 . Thus, the exact delineation of lung tumors on FDG‐PET images is a keystone in radiotherapy strategy 7 , 8 .…”

Section: Introductionmentioning

confidence: 99%

New strategy for automatic tumor segmentation by adaptive thresholding on PET/CT images

Moussallem

Valette

Traverse-Gléhen

et al. 2012

J Applied Clin Med Phys

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Tumor delineation is a critical aspect in radiotherapy treatment planning and is usually performed with the anatomical images of a computed tomography (CT) scan. For non‐small cell lung cancer, it has been recommended to use functional positron emission tomography (PET) images to take into account the biological target characteristics. However, today, there is no satisfactory segmentation technique for PET images in clinical applications. In the present study, a solution to this problem is proposed. The development of the segmentation technique is based on the threshold's adjustment directly from patients, rather than from phantoms. To this end, two references were chosen: measurements performed on CT images of the selected lesions, and histological measurements of surgically removed tumors. The inclusion and exclusion criteria were chosen to produce references that are assumed to have measured tumor sizes equal to the true in vivo tumor sizes. In total, for the two references, 65 lung lesions of 54 patients referred for FDG‐PET/CT exams were selected. For validation, measurements of segmented lesions on PET images using this technique were also compared to CT and histological measurements. For lesions greater than 20 mm, our segmentation technique showed a good estimation of histological measurements (mean difference between measured and calculated data equal to −0.8±9.0%) and an acceptable estimation of CT measurements. For lesions smaller than or equal to 20 mm, the method showed disagreement with the measurements derived from histological or CT data. This novel segmentation technique shows high accuracy for the lesions with largest axes between 2 and 4.5 cm. However, it does not correctly evaluate smaller lesions, likely due to the partial volume effect and/or respiratory motions.PACS numbers: 87.53.Bn, 87.53.Kn, 87.55.D, 87.57.nm, 87.57.U

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Increased therapeutic ratio by 18FDG-PET CT planning in patients with clinical CT stage N2-N3M0 non–small-cell lung cancer: A modeling study

Cited by 149 publications

References 33 publications

18F-Fluorodeoxyglucose Positron Emission Tomography-Based Assessment of Local Failure Patterns in Non–Small-Cell Lung Cancer Treated With Definitive Radiotherapy

18F-Fluorodeoxyglucose Positron Emission Tomography-Based Assessment of Local Failure Patterns in Non–Small-Cell Lung Cancer Treated With Definitive Radiotherapy

Towards Biological Target Volumes Definition for Radiotherapy Treatment Planning: Quo Vadis PET/CT?

New strategy for automatic tumor segmentation by adaptive thresholding on PET/CT images

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