HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH RSS TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Scarfone, C. Articles by Hallahan, D. E. Search for Related Content PubMed PubMed Citation Articles by Scarfone, C. Articles by Hallahan, D. E.

Prospective Feasibility Trial of Radiotherapy Target Definition for Head and Neck Cancer Using 3-Dimensional PET and CT Imaging

¹ Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
² Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
³ Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
⁴ Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
⁵ Biostatistics Shared Resource, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee

The aim of this investigation was to evaluate the influence and accuracy of ¹⁸F-FDG PET in target volume definition as a complementary modality to CT for patients with head and neck cancer (HNC) using dedicated PET and CT scanners. Methods: Six HNC patients were custom fitted with head and neck and upper body immobilization devices, and conventional radiotherapy CT simulation was performed together with ¹⁸F-FDG PET imaging. Gross target volume (GTV) and pathologic nodal volumes were first defined in the conventional manner based on CT. A segmentation and surface-rendering registration technique was then used to coregister the ¹⁸F-FDG PET and CT planning image datasets. ¹⁸F-FDG PET GTVs were determined and displayed simultaneously with the CT contours. CT GTVs were then modified based on the PET data to form final PET/CT treatment volumes. Five-field intensity-modulated radiation therapy (IMRT) was then used to demonstrate dose targeting to the CT GTV or the PET/CT GTV. Results: One patient was PET-negative after induction chemotherapy. The CT GTV was modified in all remaining patients based on ¹⁸F-FDG PET data. The resulting PET/CT GTV was larger than the original CT volume by an average of 15%. In 5 cases, ¹⁸F-FDG PET identified active lymph nodes that corresponded to lymph nodes contoured on CT. The pathologically enlarged CT lymph nodes were modified to create final lymph node volumes in 3 of 5 cases. In 1 of 6 patients, ¹⁸F-FDG–avid lymph nodes were not identified as pathologic on CT. In 2 of 6 patients, registration of the independently acquired PET and CT data using segmentation and surface rendering resulted in a suboptimal alignment and, therefore, had to be repeated. Radiotherapy planning using IMRT demonstrated the capability of this technique to target anatomic or anatomic/physiologic target volumes. In this manner, metabolically active sites can be intensified to greater daily doses. Conclusion: Inclusion of ¹⁸F-FDG PET data resulted in modified target volumes in radiotherapy planning for HNC. PET and CT data acquired on separate, dedicated scanners may be coregistered for therapy planning; however, dual-acquisition PET/CT systems may be considered to reduce the need for reregistrations. It is possible to use IMRT to target dose to metabolically active sites based on coregistered PET/CT data.

Key Words: head and neck cancer • PET • radiotherapy targets • nuclear medicine treatment planning • conformal radiotherapy

This article has been cited by other articles:

				E. C. Ford, J. Herman, E. Yorke, and R. L. Wahl 18F-FDG PET/CT for Image-Guided and Intensity-Modulated Radiotherapy J. Nucl. Med., October 1, 2009; 50(10): 1655 - 1665. [Abstract] [Full Text] [PDF]

				M. K. Chung, H.-S. Jeong, S. G. Park, J. Y. Jang, Y.-I. Son, J. Y. Choi, S. H. Hyun, K. Park, M.-J. Ahn, Y. C. Ahn, et al. Metabolic Tumor Volume of [18F]-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Predicts Short-Term Outcome to Radiotherapy With or Without Chemotherapy in Pharyngeal Cancer Clin. Cancer Res., September 15, 2009; 15(18): 5861 - 5868. [Abstract] [Full Text] [PDF]

				A. M. Scott, D. H. Gunawardana, D. Bartholomeusz, J. E. Ramshaw, and P. Lin PET Changes Management and Improves Prognostic Stratification in Patients with Head and Neck Cancer: Results of a Multicenter Prospective Study J. Nucl. Med., October 1, 2008; 49(10): 1593 - 1600. [Abstract] [Full Text] [PDF]

				M. R. Benz, V. Evilevitch, M. S. Allen-Auerbach, F. C. Eilber, M. E. Phelps, J. Czernin, and W. A. Weber Treatment Monitoring by 18F-FDG PET/CT in Patients with Sarcomas: Interobserver Variability of Quantitative Parameters in Treatment-Induced Changes in Histopathologically Responding and Nonresponding Tumors J. Nucl. Med., July 1, 2008; 49(7): 1038 - 1046. [Abstract] [Full Text] [PDF]

				T. M. Blodgett, C. C. Meltzer, and D. W. Townsend PET/CT: Form and Function Radiology, February 1, 2007; 242(2): 360 - 385. [Abstract] [Full Text] [PDF]

				P H Jarritt, K J Carson, A R Hounsell, and D Visvikis The role of PET/CT scanning in radiotherapy planning Br. J. Radiol., September 1, 2006; 79(Special_Issue_1): S27 - S35. [Abstract] [Full Text] [PDF]

				K Newbold, M Partridge, G Cook, S A Sohaib, E Charles-Edwards, P Rhys-Evans, K Harrington, and C Nutting Advanced imaging applied to radiotherapy planning in head and neck cancer: a clinical review. Br. J. Radiol., July 1, 2006; 79(943): 554 - 561. [Abstract] [Full Text] [PDF]

				P J Ell The contribution of PET/CT to improved patient management Br. J. Radiol., January 1, 2006; 79(937): 32 - 36. [Abstract] [Full Text] [PDF]

				U. Nestle, S. Kremp, A. Schaefer-Schuler, C. Sebastian-Welsch, D. Hellwig, C. Rube, and C.-M. Kirsch Comparison of Different Methods for Delineation of 18F-FDG PET-Positive Tissue for Target Volume Definition in Radiotherapy of Patients with Non-Small Cell Lung Cancer J. Nucl. Med., August 1, 2005; 46(8): 1342 - 1348. [Abstract] [Full Text] [PDF]

				T.-C. Yen, J. T.-C. Chang, S.-H. Ng, Y.-C. Chang, S.-C. Chan, H.-M. Wang, L.-C. See, T.-M. Chen, C.-J. Kang, Y.-F. Wu, et al. Staging of Untreated Squamous Cell Carcinoma of Buccal Mucosa with 18F-FDG PET: Comparison with Head and Neck CT/MRI and Histopathology J. Nucl. Med., May 1, 2005; 46(5): 775 - 781. [Abstract] [Full Text] [PDF]

				T. M. Blodgett, B. Casagranda, D. W. Townsend, and C. C. Meltzer Issues, Controversies, and Clinical Utility of Combined PET/CT Imaging: What Is the Interpreting Physician Facing? Am. J. Roentgenol., May 1, 2005; 184(5_supp): S138 - S145. [Abstract] [Full Text] [PDF]