CT and 18F-deoxyglucose (FDG) image fusion for optimization of conformal radiotherapy of lung cancers

Giraud, P.; Grahek, D.; Montravers, F.; Carette, Marie-France; Deniaud-Alexandre, É.; Julia, Fredéric; Rosenwald, Jean-Claude; Cosset, Jean‐Marc; Talbot, Jean-Noël; Housset, M.; Touboul, E.

doi:10.1016/s0360-3016(00)01579-0

Cited by 128 publications

(60 citation statements)

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“…Interphysician variability in target volume delineation has been found to be a great source of inconsistency in treatment planning for NSCLC (7,8). 18 F-fluorodeoxyglucose positron emission tomography ( 18 FDG-PET) has been used as a method to improve the accuracy of target delineation and has been shown to reduce interobserver variability in NSCLC (9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

“…Information from 18 FDG-PET scans can lead to altered staging and target volumes either by upstaging, because of previously undetected nodal disease, or downstaging, because of atelectasis or previously suspicious nodal disease found to be metabolically insignificant (8,9,(16)(17)(18)(19)(20). The effect of pre-RT 18 FDG-PET data incorporation into treatment planning on the patterns of local failure has been insufficiently investigated.…”

Section: Introductionmentioning

confidence: 99%

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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: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

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 authors concluded that coregistration systems could facilitate target definition and treatment planning. Another study came to a similar conclusion for CT and GCI images [104]. Three-dimensional (3D) fusion of these images was used for virtual simulation in 12 patients, using four landmarks drawn on the patient9s skin.…”

Section: Levels)mentioning

confidence: 76%

Imaging in lung cancer: positron emission tomography scan

Vansteenkiste¹

2002

European Respiratory Journal

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In the past 5 yrs, positron emission tomography (PET), usually used with 18 F-fluoro-2-deoxy-glucose (FDG), has become an important imaging modality in lung cancer patients.Currently, the use of FDG-PET in respiratory oncology is mainly for diagnosis and staging. Standard indications are the evaluation of an indeterminate solitary pulmonary nodule or mass, where FDG-PET has proven to be significantly more accurate than computed tomography (CT) in the distinction between benign and malignant lesions. Several studies have also convincingly demonstrated that locoregional lymph node staging by FDG-PET (in correlation with CT images) is significantly superior to CT, with a negative predictive value equal or even superior to mediastinoscopy. FDG-PET also improves extrathoracic staging, through the detection of lesions missed at conventional imaging or characterization of lesions that remain equivocal on conventional imaging. Many European countries now have or plan reimbursement in these indications. Large-scale randomized studies should now focus on the impact this accurate tumour imaging technique has on treatment outcome and cost-efficacy.Ongoing studies in specialized centres focus on the use of FDG-PET in more advanced clinical applications, such as planning radiotherapy, response evaluation after radiotherapy or (induction) chemotherapy, follow-up and early detection of recurrence, and prognostic information in this in vivo measurement of tumour glucose metabolism.After a short note on the technique used and a summary of the current common indications of diagnosis and staging, this paper will deal mainly with two of the more advanced clinical applications of FDG-PET in locally advanced nonsmall cell lung cancer: radiation treatment planning and assessment of induction chemotherapy.Finally, it should be mentioned that a whole new field of applications of positron emission tomography in molecular biology, using new radiopharmaceutical probes, is under extensive investigation. These techniques are promising for future use in very early response monitoring during chemo-or radiotherapy, in evaluation of novel molecular-targeted lung cancer therapies, or even gene therapy.

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“…Lung carcinoma patients: Giraud et al [46] reported on the impact of FDG-PET based coincidence mode dual-head gamma camera images co-registered with the planning CT images for 12 NSCLC patients. The radiation oncologist outlined the target volume on the CT images first and then altered (if necessary) these volumes based on the PET/ CT co-registration.…”

Section: Clinical Implementationsmentioning

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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CT and 18F-deoxyglucose (FDG) image fusion for optimization of conformal radiotherapy of lung cancers

Cited by 128 publications

References 41 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

Imaging in lung cancer: positron emission tomography scan

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

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