Use of single MRI and 18F‐FDG PET‐CT scans in both diagnosis and radiotherapy treatment planning in patients with head and neck cancer: Advantage on target volume and critical organ delineation (original) (raw)
Related papers
PET/CT significance for planning radiotherapy of head and neck cancer
Neoplasma, 2012
The combination of positron emission tomography and computed tomography (PET/CT) offers metabolic mapping in addition to anatomic information of the primary lesion, nodal and distant metastases in patients with head and neck tumors, and may be therefore beneficial for radiotherapy planning. The aim of our study was to evaluate benefits of combined PET and CT imaging for staging and target volume delineation in this group of patients.Fifty three patients (40 men and 13 women) with confirmed advanced, inoperable or non-radically operated head and neck cancer were assessed based on the results of PET/CT as well as standard diagnostic examinations. All patients were subsequently treated with intensity modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) of 6 MV X-rays. There was an agreement between the standard examinations results and results of PET/CT in 30 cases. In 23 cases there was disagreement either in tumor size, nodal involvement or presence of distant metas...
18F-FDG-PET imaging in radiotherapy tumor volume delineation in treatment of head and neck cancer
Radiotherapy and Oncology, 2011
F-FDG-PET PET/CT imaging Target volumes delineation Treatment planning Lymph nodes Head and neck cancer a b s t r a c t Purpose: To determine the impact of 18 F-fluorodeoxyglucose positron emission tomography (PET) in radiotherapy target delineation and patient management for head and neck squamous cell carcinoma (HNSCC) compared to computed tomography (CT) alone. Materials and methods: Twenty-nine patients with HNSCC were included. CT and PET/CT obtained for treatment planning purposes were reviewed respectively by a neuroradiologist and a nuclear medicine specialist who were blinded to the findings from each other. The attending radiation oncologist together with the neuroradiologist initially defined all gross tumor volume of the primary (GTVp) and the suspicious lymph nodes (GTVn) on CT. Subsequently, the same radiation oncologist and the nuclear medicine specialist defined the GTVp and GTVn on 18 F-FDG-PET/CT. Upon disagreement between CT and 18 F-FDG-PET on the status of a particular lymph node, an ultrasound-guided fine needle aspiration was performed. Volumes based on CT and 18 F-FDG-PET were compared with a paired Student's t-test. Results: For the primary disease, four patients had previous diagnostic tonsillectomy and therefore, FDG uptake occurred in 25 patients. For these patients, GTVp contoured on 18 F-FDG-PET (GTVp-PET) were smaller than the GTVp contoured on CT (GTVp-CT) in 80% of the cases, leading to a statistically significant volume difference (p = 0.001). Of the 60 lymph nodes suspicious on PET, 55 were also detected on CT. No volume change was observed (p = 0.08). Ten biopsies were performed for lymph nodes that were discordant between modalities and all were of benign histology. Distant metastases were found in two patients and one had a newly diagnosed lung adenocarcinoma. Conclusions: GTVp-CT was significantly larger when compared to GTVp-PET. No such change was observed for the lymph nodes. 18 F-FDG-PET modified treatment management in three patients, including two for which no curative radiotherapy was attempted. Larger multicenter studies are needed to ascertain whether combined 18 F-FDG-PET/CT in target delineation can influence the main clinical outcomes.
Advances in Modern Oncology Research, 2017
Accurate tumor diagnosis is important in highly conformal techniques such as Intensity Modulated radiotherapy (IMrT), which aims for high therapeutic ratio. We compared gross Tumor Volume (gTV) (primary and nodal) delineated on 18 F-fluorodeoxyglucose positron emission tomography ([ 18 F]-FDg-PeT) scan to those delineated on contrast-enhanced computed tomography (CeCT) scan and its impact on staging treated by IMrT. A total of 30 consecutive patients with locally advanced squamous cell carcinoma of head and neck were included in this study. FDg-PeT and CeCT scans were performed with dedicated positron emission tomography-computed tomography (PeT/CT) scanner in a single session as part of radiotherapy treatment planning for IMrT. After treatment with concurrent chemoradiotherapy, all patients were followed for one year. Three out of 30 patients were excluded from the final analysis, as there was complete remission in PET/CT after neoadjuvant chemotherapy. For remaining 27 cases, the primary sites were 17 oropharynx, 2 hypopharynx, 7 larynx and 1 unknown primary with secondary neck node. PeT-CT resulted in changes of CT-based staging in 25% patients (upstaged in 3 and down-staged in 4). gTV delineated on PeT vs. CT scan was gTV-PeT (primary) of 20.15 cm 3 vs. gTV-CT (primary) of 18.75 cm 3 , p = 0.803; and gTV-PeT (nodes) of 28.45 cm 3 vs. gTV-CT (nodes) of 21.56 cm 3 , p = 0.589. The mismatch between two target volumes was statistically insignificant (p = 0.635 for gTV primary, p = 0.187 for nodes). The mean gTV-PeT outside CT for primary was 5.83 cm 3 , and for node was 8.47 cm 3. Median follow-up was 12 months. Oneyear loco-regional control was 92%. The target delineation of GTV can be improved with functional imaging [ 18 F]-FDg-PeT/ CT.
International Journal of Radiation Oncology*Biology*Physics, 2009
Purpose: To evaluate the effect of the use of 18 F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/ computed tomography (CT) in radiotherapy target delineation for head-and-neck cancer compared with CT alone. Methods and Materials: A total of 38 consecutive patients with head-and-neck cancer were included in this study. The primary tumor sites were as follow: 20 oropharyngeal tumors, 4 laryngeal tumors, 2 hypopharyngeal tumors, 2 paranasal sinuses tumors, 9 nasopharyngeal tumors, and 1 parotid gland tumor. The FDG-PET and CT scans were performed with a dedicated PET/CT scanner in one session and then fused. Subsequently, patients underwent treatment planning CT with intravenous contrast enhancement. The radiation oncologist defined all gross tumor volumes (GTVs) using both the PET/CT and CT scans. Results: In 35 (92%) of 38 cases, the CT-based GTVs were larger than the PET/CT-based GTVs. The average total GTV from the CT and PET/CT scans was 34.54 cm 3 (range, 3.56-109) and 29.38 cm 3 (range, 2.87-95.02), respectively (p < 0.05). Separate analyses of the difference between the CT-and PET/CT-based GTVs of the primary tumor compared with the GTVs of nodal disease were not statistically significant. The comparison between the PET/ CT-based and CT-based boost planning target volumes did not show a statistically significant difference. All patients were alive at the end of the follow-up period (range, 3-38 months). Conclusion: GTVs, but not planning target volumes, were significantly changed by the implementation of combined PET/CT. Large multicenter studies are needed to ascertain whether combined PET/CT in target delineation can influence the main clinical outcomes. Ó
International Journal of Radiation Oncology*Biology*Physics, 2002
Purpose: Accurate diagnosis of tumor extent is important in three-dimensional conformal radiotherapy. This study reports the use of image fusion between (18)F-fluoro-2-deoxy-D-glucose positron emission tomography ( 18 FDG-PET) and magnetic resonance imaging/computed tomography (MRI/CT) for better targets delineation in radiotherapy planning of head-and-neck cancers. Methods and Materials: The subjects consisted of 12 patients with oropharyngeal carcinoma and 9 patients with nasopharyngeal carcinoma (NPC) who were treated with radical radiotherapy between July 1999 and February 2001. Image fusion between 18 FDG-PET and MRI/CT was performed using an automatic multimodality image registration algorithm, which used the brain as an internal reference for registration. Gross tumor volume (GTV) was determined based on clinical examination and 18 FDG uptake on the fusion images. Clinical target volume (CTV) was determined following the usual pattern of lymph node spread for each disease entity along with the clinical presentation of each patient.
Journal of Oral and Maxillofacial Surgery, 2003
The aims of this study were to evaluate the use of [ 18 F]fluorodeoxyglucose positron emission tomography (FDG-PET) in the staging of primary and recurrent tumors of the head and neck in comparison to routine clinical methods (physical examination, ultrasonography, computed tomography) and to investigate the effect of FDG-PET scanning on therapeutic strategy. Materials and Methods: Retrospective analysis of the results of FDG-PET and conventional diagnostic modalities were compared with biopsy results or patient outcome or both. In a period of 6 years, 78 FDG-PET studies were performed on 56 patients; 24 of them before therapy and 54 on suspicion of residual or recurrent tumor. The evaluation of the diagnostic results was performed separately for the primary site and the nodal sites of the neck and for tumor occurrence in the trunk. Results: In detecting the primary site, FDG-PET results reached a sensitivity of 93%, a specificity of 100%, and an accuracy of 94%. In detecting the nodal sites, similar results of 94%, 97%, and 96% were seen, respectively. In detecting tumor occurrence in the trunk, results were 83%, 100%, and 98%, respectively. The McNemar test did not prove any statistically significant difference between FDG-PET and the evaluated conventional methods. When used in conjunction with conventional diagnostic tests, 22% of the PET scans gave important additional information. Finally, 11% of the performed PET scans led to a change in therapeutic planning. Conclusions: Our results show that FDG-PET is a reliable method to detect tumors in all tumor sites. Therefore, we recommend that FDG-PET scanning be performed routinely as a first diagnostic step in pretherapeutic staging of patients with biopsy-proven head and neck cancer.
Asian Pacific journal of cancer prevention : APJCP, 2014
In this study, we aimed to investigate the benefits of 18F-deoxyglucose positron emission tomography/computed tomography (FGD-PET/CT) imaging for staging and radiotherapy planning in patients with head and neck cancer undergoing definitive radiotherapy. Thirty-seven head and neck cancer patients who had undergone definitive radiotherapy and PET/CT at the Uludag University Medical Faculty Department of Radiation Oncology were investigated in order to determine the role of PET/CT in staging and radiotherapy planning. The median age of this patient group of 32 males and 5 females was 57 years (13-84years). The stage remained the same in 18 cases, decreased in 5 cases and increased in 14 cases with PET/CT imaging. Total gross tumor volume (GTV) determined by CT (GTVCT-Total) was increased in 32 cases (86.5%) when compared to total GTV determined by PET/CT (GTVPET/CT-Total). The GTV of the primary tumor determined by PET/CT (GTVPET/CT) was larger in 3 cases and smaller in 34 cases compar...
La Radiologia medica, 2017
To analyze the impact of 18F-fluorodeoxyglucose-PET/CT (PET/CT) in the radiotherapy (RT) planning strategy in HNC, correlating CT-scan and PET/CT performances. Inclusion criteria were: age >18 years old, histologically proven head and neck cancer (HNC), patients candidate to definitive RT ± chemotherapy, stage of disease by means of PET/TC and CT-scan performed at our Cancer Care Center. Sixty patients were analyzed. The following primary tumor sites were investigated: nasopharynx (13%), oropharynx (42%), oral cavity (32%) and larynx non-glottic (13%). Globally, PET/CT findings caused changes on nodal radiation treatment volumes in 10% of all the population of study. Specifically, in 5 cases out of 19 oral cavity tumors (26%), PET/CT detected neck-nodes positive (not detected at CT-scan). These findings have allowed to change the patients management, including PET/CT neck-nodes positive in the high-risk RT volumes. In the RT planning strategy, the present findings support the use...