FDG-PET/CT imaging for staging and radiotherapy treatment planning of head and neck carcinoma (original) (raw)
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Impact of PET/CT on planning of radiotherapy in head and neck cancer
The quarterly journal of nuclear medicine and molecular imaging : official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), [and] Section of the Society of Radiopharmaceutical Chemistry and Biology, 2010
Radiation therapy (RT) has a prominent role in the treatment of locally advanced head and neck cancer. Image and biologically guided intensity modulated RT are becoming strongholds of state-of-the-art management with positron emission tomography (PET)/computed tomography (CT) as the preferred diagnostic tool in treatment planning. The procedures required in the workflow from diagnosis to treatment plan are complex and consensus on optimal image acquisition, reconstruction parameters and contouring methods remains to be established. In spite of this the potential of PET/CT-based treatment planning has been widely recognized and many large referral centres have adopted the technique in either a routine or an experimental setting. PET/CT with 2-deoxy-2-[¹⁸F]fluoro-D-glucose ([¹⁸F]FDG) assists in selection of correct treatment goal and dose optimisation and increases the confidence of contouring process modifying treatment plan in most patients. For dose escalation and adaptive RT strat...
Acta Oncologica, 2008
Background and purpose. As techniques for radiotherapy delivery have developed, increasingly accurate localisation of disease is demanded. Functional imaging, particularly PET and its fusion with anatomical modalities, such as PET/CT, promises to improve detection and characterisation of disease. This study evaluated the impact of 18 FDG-PET/CT on radiotherapy target volume definition in head and neck cancer (HNC). Materials and methods. The PET/CT scans of patients with HNC were used in a radiotherapy planning (RTP) study. The gross tumour volume (GTV), clinical target volume (CTV) and planning target volume (PTV) were defined conventionally and compared to those defined using the PET/CT. Data were reported as the median value with 95% confidence intervals. Results. Eighteen patients were consented, 9 had known primary tumour site, 9 presented as unknown primary. In nine cases where the primary site was known, the combined primary and nodal GTV (GTVp'n) increased by a median of 6.1 cm 3 (2.6, 12.2) or 78% (18, 313), p 00.008 with CTV increasing by a median of 10.1 cm 3 (1.3, 30.6) or 4% (0, 13) p 00.012. In 9 cases of unknown primary the GTVp'n increased by a median 6.3 cm 3 (0.2, 15.7) or 61% (4, 210), p 00.012, with CTV increasing by a median 155.4 cm 3 (2.7, 281.7) or 95% (1, 137), p 00.008. Conclusion. 18 FDG-PET revealed disease lying outside the conventional target volume, either extending a known area or highlighting a previously unknown area of disease, including the primary tumour in 5 cases. We recommend PET/CT in the RTP of all cases of unknown primary. In patients with a known primary, although the change in volume was statistically significant the clinical impact is less clear. 18 FDG-PET can also show areas within the conventional target volume that are hypermetabolic which may be possible biological target volumes for dose escalation studies in the future.
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
Head & Neck, 2009
BackgroundThe use of a single MRI and 18F‐fluoro deoxyglucose positron emission tomography‐CT (18F‐FDG PET‐CT) was evaluated, both in diagnostic procedure and radiotherapy planning, in patients with head and neck cancer.MethodsThirty‐five patients with nasopharyngeal and oropharyngeal tumors were studied. The MRI and 18F‐FDG PET‐CT were used for both diagnostic work‐up and gross tumor volume and critical structure delineation. The interobserver variation (IOV) of volumes determined on MRI and CT by a radiotherapist and by a radiologist were compared as well as their impact on dose distribution.ResultsThe CT‐MRI decreased the IOV of parotid glands in 12 of 35 and target volume in 15 of 35 patients. The use of 18F‐FDG PET‐CT changed the treatment design in 6 of 21 patients.ConclusionsDiagnostic imaging performed in the treatment position can improve the accuracy of radiotherapy planning in case of intracranial tumor extension, heavy dental work, or contraindication for contrast‐enhanc...
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...
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.
Medicina
Background and objectives: Induction chemotherapy (ICT) before definitive chemoradiation (CRT) gives high response rates in locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). However, pre-ICT gross tumor volume (GTV) for radiotherapy (RT) planning is still recommended. As 18F-FDG PET/CT has an advantage of biological tumor information comparing to standard imaging methods, we aimed to evaluate the feasibility of 18F-FDG PET/CT-based post-ICT GTV delineation for RT planning in LA-SCCHN and to assess the prognostic value of PET parameters: maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Methods: 47 LA-SCCHN patients were treated with 3 cycles of ICT (docetaxel, cisplatin, and 5-fluorouracil) followed by CRT (70 Gy in 35 fractions with weekly cisplatin). Pre- and post-ICT PET/CT examinations were acquired. Planning CT was co-registered with post-ICT PET/CT and RT target volumes were contoured according t...
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...
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.