PET/CT and Hypo-Fractionated Radiotherapy of Patients with Head and Neck Cancer (original) (raw)
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Journal of Diagnostic Imaging in Therapy
In previous years FDG-PET/CT has acquired a significant role in radiotherapy treatment of head and neck (H&N) disease. This study focuses on the added value of PET/CT with respect to conventional CT in terms of target delineation and dosimetric implications. Materials and Methods. Thirty patients with H&N cancer who underwent FDG-PET/CT examination were analysed retrospectively. Gross tumour volumes were first delineated on CT (CT-GTVs) blinded to PET data and successively on the co-registered PET/CT (PET-GTVs). Both volumes were visible on the fused images. CT and PET/CT volumes were compared. The aim was to understand if tumour regions might be omitted if PET data is not considered in the planning stage. A simulation of a treatment plan was developed based on the CT-GTVs and the dosimetric coverage of PEThighlighted tumour regions were evaluated. Results. The mismatching fraction between PET and CT volumes (56%) indicates that PET significantly changes the GTV definition. A simulation of a CT-based treatment plan resulted in 23% of the analysed patients having important underdosages in PET volumes (primary tumour) in the range (-96.5% to-27.4%) while the lymph nodes were underdosaged in the range (-99.1% to-25.1%) for 33% of patients. Conclusions. In radiotherapy treatment of H&N disease, PET/CT provides a better target definition and prevents exclusion of pathologic regions. In the population that we analysed here, PET data integrating other conventional diagnostic modalities such as CE-CT, MRI or US avoids significant underdosages of the tumour tissue in 37% of patients.
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...
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.
Background and objectives: Induction chemotherapy (ICT) before definitive chemoradiation (CRT) gives high response rates in LA-SCCHN. However, pre-ICT gross tumour volume (GTV) for radiotherapy (RT) planning is still recommended. As 18F-FDG PET/CT has an advantage of biological tumour 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 tumour 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 to post-ICT PET. Post-ICT percentage decrease of SUVmax, MTV a...
2020
ObjectiveTo analyze the pattern of failure in relation to pre-treatment [18F] FDG-PET/CT uptake in head and neck squamous cell carcinoma (HNSCC) patients treated with definitive radio-chemotherapy (RT-CHT).Methods and MaterialsFrom 2012 to 2016, 87 HNSCC patients treated with definitive RT-CHT, with intensity modulated radiation therapy with simultaneous integrated boost (IMRT-SIB), underwent pre-treatment [18F] FDG-PET/CT (PETpre), and MRI/CT for radiotherapy (RT) planning purposes. Patients with local recurrence, received [18F] FDG-PET/CT, (PETrec) at the time of the discovery of recurrence. In these patients, the biological target volume (BTV), BTVpre and BTVrec were segmented on PET images by means of an adaptive thresholding algorithm. The overlapping volume between BTVpre and BTVrec (BTVpre&rec) was generated and the dose coverage of BTVrec and BTVpre&rec was checked on the planning CT using the D99 and D95 dose metrics. The recurrent volume was defined as: ‘‘In-Field (IF)’’, ...
Annals of Nuclear Medicine, 2012
Objective To compare the prognostic utility of the 2-[18F] fluoro-2-deoxy-d-glucose (FDG) maximum standardized uptake value (SUVmax), primary gross tumor volume (GTV), and FDG metabolic tumor volume (MTV) for disease control and survival in patients with head and neck squamous cell carcinoma (HNSCC) undergoing intensity-modulated radiotherapy (IMRT). Methods Between 2007 and 2011, 41 HNSCC patients who underwent a staging positron emission tomography with computed tomography and definitive IMRT were identified. Local (LC), nodal (NC), distant (DC), and overall (OC) control, overall survival (OS), and disease-free survival (DFS) were assessed using the Kaplan–Meier product-limit method. Results With a median follow-up of 24.2 months (range 2.7–56.3 months) local, nodal, and distant recurrences were recorded in 10, 5, and 7 patients, respectively. The median SUVmax, GTV, and MTV were 15.8, 22.2 cc, and 7.2 cc, respectively. SUVmax did not correlate with LC (p = 0.229) and OS (p = 0.66...
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...
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