USING FLUORODEOXYGLUCOSE POSITRON EMISSION TOMOGRAPHY TO ASSESS TUMOR VOLUME DURING RADIOTHERAPY FOR NON-SMALL-CELL LUNG CANCER AND ITS POTENTIAL IMPACT ON ADAPTIVE DOSE ESCALATION AND NORMAL TISSUE SPARING

被引:125
作者
Feng, Mary [1 ]
Kong, Feng-Ming [1 ]
Gross, Milton [2 ]
Fernando, Shaneli [1 ]
Hayman, James A. [1 ]
Ten Haken, Randall K. [1 ]
机构
[1] Univ Michigan, Dept Radiat Oncol, Ann Arbor, MI 48109 USA
[2] Univ Michigan, Dept Nucl Med, Ann Arbor, MI 48109 USA
来源
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS | 2009年 / 73卷 / 04期
关键词
Lung cancer; Dose escalation; PET; Adaptive therapy; CONFORMAL RADIATION-THERAPY; THRESHOLD SEGMENTATION; THORACIC RADIOTHERAPY; PHASE-III; PNEUMONITIS; CHEMOTHERAPY; DELINEATION; CARCINOMA; CONCURRENT; NSCLC;
D O I
10.1016/j.ijrobp.2008.10.054
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: To quantify changes in fluorodeoxyglucose (FDG)-avid tumor volume on positron emission tomography/computed tomography (PET/CT) during the course of radiation therapy and examine its potential use in adaptive radiotherapy for tumor dose escalation or normal tissue sparing inpatients with non-small-cell lung cancer (NSCLC). Methods and Materials: As part of a pilot study, patients with Stage I-III NSCLC underwent FDG-PET/CT before radiotherapy (RT) and in mid-RT (after 40-50 Gy). Gross tumor volumes were contoured on CT and PET scans obtained before and during RT. Three-dimensional conformal RT plans were generated for each patient, first using only pretreatment CT scans. Mid-RT PET volumes were then used to design boost fields. Results: Fourteen patients with FDG-avid tumors were assessed. Two patients had a complete metabolic response, and 2 patients had slightly increased FDG uptake in the adjacent lung tissue. Mid-RT PET scans were useful in the 10 remaining patients. Mean decreases in CT and PET tumor volumes were 26% (range, +15% to -75%) and 44% (range, +10% to -100%), respectively. Designing boosts based on mid-RT PET allowed for a meaningful dose escalation of 30-102 Gy (mean, 58 Gy) or a reduction in normal tissue complication probability (NTCP) of 0.4-3% (mean, 2%) in 5 of 6 patients with smaller yet residual tumor volumes. Conclusions: Tumor metabolic activity and volume can change significantly after 40-50 Gy of RT. Using mid-RT PET volumes, tumor dose can be significantly escalated or NTCP reduced. Clinical studies evaluating patient outcome after PET-based adaptive RT are ongoing. Published by Elsevier Inc.
引用
收藏
页码:1228 / 1234
页数:7
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