PET-basierte Bestrahlungsplanung

Abstract

Head and neck tumours are associated with high morbidity and mortality. Radiotherapy is an integral part of the treatment of these tumours and [18F]-FDG-PET/CT or PET/MRI is becoming increasingly important in the personalised treatment of head and neck cancer. Advanced tumour stage radiotherapy is combined with chemotherapy and/or surgery. The paper deals with the elementary importance of measuring the exact tumour extent and the resulting determination of the tumour volumes in image-based radiotherapy planning as the basis for successful irradiation. The PET/CT-based target volume definition results in target volume reduction with consecutive protection of risk organs and healthy tissue. Increased glucose metabolism and hypoxic states of cancerous lesions allows PET/CT to correctly identify tumour regions and thereby helps in potential dose escalation for tumour control. PET/MRI shows promising results in the diagnosis of relapses after radiotherapy, but requires further evaluation in larger studies. The [18F]-FDG-PET/CT is ideally suited for therapy evaluation and recurrence diagnosis and has found its way into the ambulatory reimbursement system with some indications due to randomised studies with the highest level of evidence. In addition, the increasing use of machine learning in radiation therapy is emphasised.