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Implementing Biologic Target Volumes in Radiation Treatment Planning for Non-Small Cell Lung Cancer

Jeffrey D. Bradley, MD1,3, Carlos A. Perez, MD1,3, Farrokh Dehdashti, MD2,3 and Barry A. Siegel, MD2,3

1 Department of Radiation Oncology, Mallinckrodt Institute of Radiology, St. Louis, Missouri
2 Department of Radiology, Mallinckrodt Institute of Radiology, St. Louis, Missouri
3 Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri



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  		FIGURE 1. Fused PET/CT images of patient with T4 N2 M0, stage IIIB NSCLC. Patient has 2 primary lesions in right lower lobe (best seen in C) with adenopathy in subcarinal (A) and right paratracheal regions (B). PET and CT images were coregistered with aid of fiducial markers, 1 of which is shown in A. (D) Beam arrangement used to cover biologic target volume.

 


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  		FIGURE 2. PET/CT images of patient with T2 N3 M0, stage IIIB NSCLC, showing biologic target volume to include right upper lobe lesion (A and C), ipsilateral cervical adenopathy (B and D), and bulky subcarinal adenopathy (D). Cervical adenopathy was not appreciated on previous CT examination of thorax but was detected with PET.

 


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  		FIGURE 3. PET images in patient with right hilar cancer. (A) PET threshold is set at 40% of maximum standard uptake value (SUV) of tumor. (B) PET threshold is set at 30% of maximum SUV. If delineating this tumor using PET alone, different threshold settings would result in different target volumes.

 




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